Human antibodies to respiratory syncytial virus F protein and methods of use thereof

ABSTRACT

The present invention provides fully human antibodies that bind to respiratory syncytial virus F protein, compositions comprising the antibodies and methods of use. The antibodies of the invention are useful for preventing fusion of the virus with the cell membrane and preventing cell to cell spread of the virus, thereby providing a means of preventing the infection, or treating a patient suffering from the infection and ameliorating one or more symptoms or complications associated with the viral infection. The antibodies may also be useful for diagnosis of an infection by RSV.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/207,797, filed Mar. 13, 2014, which claims the benefit under 35 USC §119(e) of U.S. Provisional Application Nos. 61/782,215, filed Mar. 14,2013 and 61/911,093, filed Dec. 3, 2013, each of which is hereinspecifically incorporated by reference in its entirety.

SEQUENCE LISTING

This application incorporates by reference the Sequence Listingsubmitted in Computer Readable Form as file 480467-Sequence.txt, createdon Aug. 5, 2016 and containing 149,291 bytes.

FIELD OF THE INVENTION

The present invention is related to human antibodies and antigen-bindingfragments of human antibodies that specifically bind to RespiratorySyncytial Virus F protein (RSV-F), compositions comprising theseantibodies and methods of using these antibodies.

STATEMENT OF RELATED ART

Respiratory syncytial virus (RSV) is a negative sense, single strandedRNA virus that is the leading cause of serious respiratory tractinfections in infants and children, with the primary infection occurringin children from 6 weeks to 2 years of age and uncommonly in the first 4weeks of life during nosocomial epidemics (Hall et al., 1979, New Engl.J. Med. 300:393-396). (Feigen et al., eds., 1987, In: Textbook ofPediatric Infectious Diseases, W B Saunders, Philadelphia at pages1653-1675; New Vaccine Development, Establishing Priorities, Vol. 1,1985, National Academy Press, Washington D.C. at pages 397-409;Ruuskanen et al., 1993, Curr. Probl. Pediatr. 23:50-79; Hall et al.,1979, New Engl. J. Med. 300:393-396). Certain populations of childrenare at risk for developing an RSV infection and these include preterminfants (Hall et al., 1979, New Engl. J. Med. 300:393-396), childrenwith congenital malformations of the airway, children withbronchopulmonary dysplasia (Groothuis et al., 1988, Pediatrics82:199-203), children with congenital heart disease (MacDonald et al.,New Engl. J. Med. 307:397-400), and children with congenital or acquiredimmunodeficiency (Ogra et al., 1988, Pediatr. Infect. Dis. J. 7:246-249;and Pohl et al., 1992, J. Infect. Dis. 165:166-169), and cystic fibrosis(Abman et al., 1988, J. Pediatr. 113:826-830).

RSV can infect the adult population as well. In this population, RSVcauses primarily an upper respiratory tract disease, although elderlypatients may be at greater risk for a serious infection and pneumonia(Evans, A. S., eds., 1989, Viral Infections of Humans. Epidemiology andControl, 3^(rd) ed., Plenum Medical Book, New York at pages 525-544), aswell as adults who are immunosuppressed, particularly bone marrowtransplant patients (Hertz et al., 1989, Medicine 68:269-281). Other atrisk patients include those suffering from congestive heart failure andthose suffering from chronic obstructive pulmonary disease (ie. COPD).There have also been reports of epidemics among nursing home patientsand institutionalized young adults (Falsey, A. R., 1991, Infect. ControlHosp. Epidemiol. 12:602-608; and Garvie et al., 1980, Br. Med. J.281:1253-1254).

While treatment options for established RSV disease are limited, moresevere forms of the disease of the lower respiratory tract often requireconsiderable supportive care, including administration of humidifiedoxygen and respiratory assistance (Fields et al., eds, 1990, FieldsVirology, 2^(nd) ed., Vol. 1, Raven Press, New York at pages 1045-1072).

Ribavirin, which is the only drug approved for treatment of infection,has been shown to be effective in the treatment of pneumonia andbronchiolitis associated with RSV infection, and has been shown tomodify the course of severe RSV disease in immunocompetent children(Smith et al., 1991, New Engl. J. Med. 325:24-29). The use of ribavirinis limited due to concerns surrounding its potential risk to pregnantwomen who may be exposed to the aerosolized drug while it is beingadministered in a hospital environment.

Similarly, while a vaccine may be useful, no commercially availablevaccine has been developed to date. Several vaccine candidates have beenabandoned and others are under development (Murphy et al., 1994, VirusRes. 32:13-36). The development of a vaccine has proven to beproblematic. In particular, immunization would be required in theimmediate neonatal period since the peak incidence of lower respiratorytract disease occurs at 2-5 months of age. However, it is known that theneonatal immune response is immature at that time. Plus, the infant atthat point in time still has high titers of maternally acquired RSVantibody, which might reduce vaccine immunogenicity (Murphy et al.,1988, J. Virol. 62:3907-3910; and Murphy et al., 1991, Vaccine9:185-189).

Two glycoproteins, F and G, on the surface of RSV have been shown to betargets of neutralizing antibodies (Fields et al., 1990, supra; andMurphy et al., 1994, supra). These two proteins are also primarilyresponsible for viral recognition and entry into target cells; G proteinbinds to a specific cellular receptor and the F protein promotes fusionof the virus with the cell. The F protein is also expressed on thesurface of infected cells and is responsible for subsequent fusion withother cells leading to syncytia formation and cell to cell virus spread.

Currently, the only approved approach to prophylaxis of RSV disease ispassive immunization. For example, the humanized antibody, palivizumab(SYNAGIS®), which is specific for an epitope on the F protein, isapproved for intramuscular administration to pediatric patients forprevention of serious lower respiratory tract disease caused by RSV atrecommended monthly doses of 15 mg/kg of body weight throughout the RSVseason (November through April in the northern hemisphere). SYNAGIS® isa composite of human (95%) and murine (5%) antibody sequences. See,Johnson et aL, (1997), J. Infect. Diseases 176:1215-1224 and U.S. Pat.No. 5,824,307, the entire contents of which are incorporated herein byreference.

Although SYNAGIS® has been successfully used for the prevention of RSVinfection in pediatric patients, multiple intramuscular doses of 15mg/kg of SYNAGIS® are required to achieve a prophylactic effect. Thenecessity for the administration of multiple intramuscular doses ofantibody requires repeated visits to the doctor's office, which is notonly inconvenient for the patient but can also result in missed doses.

Efforts were made to improve on the therapeutic profile of an anti-RSV-Fantibody, and this lead to the identification and development ofmotavizumab, also referred to as NUMAX™. However, clinical testingrevealed that certain of the patients being administered motavizumabwere having severe hypersensitivity reactions. Further development ofthis humanized anti-RSV-F antibody was then discontinued.

Other antibodies to RSV-F protein have been described and can be foundin U.S. Pat. Nos. 6,656,467; 5,824,307, 7,786,273; 7,670,600; 7,083,784;6,818,216: 7,700,735; 7,553,489; 7,323,172; 7,229,619; 7,425,618;7,740,851; 7,658,921; 7,704,505; 7,635,568; 6,855,493; 6,565,849;7,582,297; 7,208,162; 7,700,720; 6,413,771; 5,811,524; 6,537,809;5,762,905; 7,070,786; 7,364,742; 7,879,329; 7,488,477; 7,867,497; 534411; 6,835,372; 7,482,024; 7,691,603; 8,562,996; 8,568,726;US20100015596; WO2009088159A1. To date, none other than SYNAGIS® hasbeen approved by a regulatory agency for use in preventing an RSVinfection.

Thus, a need still exists for antibodies that specifically bind to anRSV antigen, such as RSV-F, which are highly potent and which produce noadverse effects that would preclude approval for clinical use.

BRIEF SUMMARY OF THE INVENTION

The invention provides isolated fully human monoclonal antibodies (mAbs)and antigen-binding fragments thereof that bind specifically toRespiratory Syncytial Virus F protein (RSV-F). Given the role that the Fprotein plays in fusion of the virus with the cell and in cell to celltransmission of the virus, the antibodies described herein provide amethod of inhibiting that process and as such, may be used forpreventing infection of a patient exposed to, or at risk for acquiringan infection with RSV, or for treating and/or ameliorating one or moresymptoms associated with RSV infection in a patient exposed to, or atrisk for acquiring an infection with RSV, or suffering from infectionwith RSV. The antibodies described herein may also be used to prevent orto treat an RSV infection in a patient who may experience a more severeform of the RSV infection due to an underlying or pre-existing medicalcondition. A patient who may benefit from treatment with an antibody ofthe invention may be a pre-term infant, a full-term infant born duringRSV season (approximately late fall (November) through early spring(April)) that is at risk because of other pre-existing or underlyingmedical conditions including congenital heart disease or chronic lungdisease, a child greater than one year of age with or without anunderlying medical condition, an institutionalized or hospitalizedpatient, or an elderly adult (>65 years of age) with or without anunderlying medical condition, such as congestive heart failure (CHF), orchronic obstructive pulmonary disease (COPD). A patient who may benefitfrom such therapy may suffer from a medical condition resulting from acompromised pulmonary, cardiovascular, neuromuscular, or immune system.For example, the patient may suffer from an abnormality of the airway,or an airway malfunction, a chronic lung disease, a chronic orcongenital heart disease, a neuromuscular disease that compromises thehandling of respiratory secretions, or the patient may beimmunosuppressed due to severe combined immunodeficiency disease orsevere acquired immunodeficiency disease, or from any other underlyinginfectious disease or cancerous condition that results inimmunosuppression, or the patient may be immunosuppressed due totreatment with an immunosuppressive drug (e.g. any drug used fortreating a transplant patient) or radiation therapy. A patient who maybenefit from the antibodies of the invention may be a patient thatsuffers from chronic obstructive pulmonary disease (COPD), cysticfibrosis (CF), bronchopulmonary dysplasia, congestive heart failure(CHF), or congenital heart disease.

Because the antibodies of the invention are more effective atneutralization of RSV compared to known antibodies, lower doses of theantibodies or antibody fragments could be used to achieve a greaterlevel of protection against infection with RSV, and more effectivetreatment and/or amelioration of symptoms associated with an RSVinfection. Accordingly, the use of lower doses of antibodies orfragments thereof which immunospecifically bind to RSV-F antigen mayresult in fewer or less severe adverse events. Likewise, the use of moreeffective neutralizing antibodies may result in a diminished need forfrequent administration of the antibodies or antibody fragments thanpreviously envisioned as necessary for the prevention of infection, orfor virus neutralization, or for treatment or amelioration of one ormore symptoms associated with an RSV infection. Symptoms of RSVinfection may include a bluish skin color due to lack of oxygen(hypoxia), breathing difficulty (rapid breathing or shortness ofbreath), cough, croupy cough (“seal bark” cough), fever, nasal flaring,nasal congestion (stuffy nose), apnea, decreased appetite, dehydration,poor feeding, altered mental status, or wheezing.

Such antibodies may be useful when administered prophylactically (priorto exposure to the virus and infection with the virus) to lessen theseverity, or duration of a primary infection with RSV, or ameliorate atleast one symptom associated with the infection. The antibodies may beused alone or in conjunction with a second agent useful for treating anRSV infection. In certain embodiments, the antibodies may be giventherapeutically (after exposure to and infection with the virus) eitheralone, or in conjunction with a second agent to lessen the severity orduration of the primary infection, or to ameliorate at least one symptomassociated with the infection. In certain embodiments, the antibodiesmay be used prophylactically as stand-alone therapy to protect patientswho are at risk for acquiring an infection with RSV, such as thosedescribed above. Any of these patient populations may benefit fromtreatment with the antibodies of the invention, when given alone or inconjunction with a second agent, including for example, an anti-viraltherapy, such as ribavirin, or other anti-viral vaccines.

The antibodies of the invention can be full-length (for example, an IgG1or IgG4 antibody) or may comprise only an antigen-binding portion (forexample, a Fab, F(ab′)₂ or scFv fragment), and may be modified to affectfunctionality, e.g., to eliminate residual effector functions (Reddy etal., (2000), J. lmmunol. 164:1925-1933).

Accordingly, in a first aspect, the invention provides an isolatedantibody or an antigen-binding fragment thereof that specifically bindsto Respiratory Syncytial Virus F protein (RSV-F).

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody has one or moreof the following characteristics:

-   -   (a) is a fully human monoclonal antibody;    -   (b) interacts with an amino acid sequence comprising amino acid        residues ranging from about position 161 to about position 188        of SEQ ID NO: 354;    -   (c) interacts with either the serine at position 173 of SEQ ID        NO: 354, or the threonine at position 174 of SEQ ID NO: 354, or        both the serine at position 173 of SEQ ID NO: 354 and the        threonine at position 174 of SEQ ID NO: 354;    -   (d) is capable of neutralizing respiratory syncytial virus        subtype A and subtype B strains in vitro;    -   (e) demonstrates the ability to significantly reduce the nasal        and/or lung viral load in vivo in an animal model of RSV        infection; or    -   (f) inhibits fusion of the virus to the cell.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody interacts withan amino acid sequence comprising amino acid residues ranging from aboutposition 161 to about position 188 of SEQ ID NO: 354.

In one embodiment, the antibody is a fully human monoclonal antibody oran antigen-binding fragment thereof that specifically binds toRespiratory Syncytial Virus F protein (RSV-F), wherein the antibody oran antigen-binding fragment thereof interacts with an amino acidsequence comprising amino acid residues ranging from about position 161to about position 188 of SEQ ID NO: 354, and wherein the antibodyneutralizes respiratory syncytial virus subtype A and/or subtype Bstrains in vitro and in vivo.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody or theantigen-binding fragment thereof demonstrates the ability tosignificantly reduce the lung viral load in a mouse model of RSVinfection when administered at a dose ranging from about 0.05 mg/kg toabout 0.15 mg/kg.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody or theantigen-binding fragment thereof demonstrates a 1-2 logs greaterreduction of nasal and/or lung viral titers as compared to palivizumabin a cotton rat model of RSV infection when administered at a doseranging from about 0.62 mg/kg to about 5.0 mg/kg.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody or theantigen-binding fragment thereof demonstrates an ED₉₉of about 0.15 mg/kgor less when administered in a mouse model of RSV subtype A infection.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody or theantigen-binding fragment thereof demonstrates an ED₉₉of about 0.62 mg/kgor less when administered in a cotton rat model of RSV subtype Ainfection.

In one embodiment, the invention provides an isolated antibody or anantigen-binding fragment thereof that specifically binds to RespiratorySyncytial Virus F protein (RSV-F), wherein the antibody or theantigen-binding fragment thereof demonstrates an ED₉₉of about 2.5 mg/kgor less when administered in a cotton rat model of RSV subtype Binfection.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates an ED₉₉that is about 2 to 3 fold lower than theED₉₉for palivizumab or motavizumab.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates a half maximal inhibitory concentration (10₅₀) ofabout 2 pM to about 600 pM in a microneutralization assay specific forRSV subtype A strains of RSV.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates a half maximal inhibitory concentration (IC₅₀) ofabout 6 pM to about 100 pM in a microneutralization assay specific forRSV subtype B strains of RSV.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to RSV-F protein demonstrates aneutralization potency against one or more subtype A laboratory strainsof RSV that is about a 15 to 17 fold improvement over palivizumab, ordemonstrates a neutralization potency against one or more subtype Aclinical strains of RSV that is about 10 to 22 fold improvement overpalivizumab.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates a neutralization potency against one or moresubtype B laboratory strains of RSV that is about a 2 to 5 foldimprovement over palivizumab.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates a neutralization potency against one or moresubtype A laboratory strains or subtype A clinical strains of RSV thatis about a 0.5 to 2 fold improvement over AM-22.

In one embodiment, the isolated antibody or an antigen-binding fragmentthereof that specifically binds to Respiratory Syncytial Virus F protein(RSV-F), demonstrates a neutralization potency against one or moresubtype B laboratory strains of RSV that is about a 2.5 to 17 foldimprovement over AM-22.

In one embodiment, the isolated human antibody or an antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), exhibits a K_(D) ranging from 1×10⁻⁷ M to 6×10⁻¹⁰ M,as measured by surface plasmon resonance.

In one embodiment, the isolated human antibody or an antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), exhibits a K_(D) ranging from 1×10⁻⁷ M to 9×10⁻⁹ M,as measured by surface plasmon resonance.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises the three heavy chain CDRs (HCDR1, HCDR2and HCDR3) contained within a HCVR amino acid sequence selected from thegroup consisting of SEQ ID NOs: 2, 18, 34, 50, 66, 82, 98, 114, 130,146, 162, 178, 194, 210, 226, 242, 258, 274, 290, 306, 322 and 338; andthe three light chain CDRs (LCDR1, LCDR2 and LCDR3) contained within aLCVR amino acid sequence selected from the group consisting of SEQ IDNOs: 10, 26, 42, 58, 74, 90, 106, 122, 138, 154, 170, 186, 202, 218,234, 250, 266, 282, 298, 314, 330 and 346.

Methods and techniques for identifying CDRs within HCVR and LCVR aminoacid sequences are well known in the art and can be used to identifyCDRs within the specified HCVR and/or LCVR amino acid sequencesdisclosed herein. Exemplary conventions that can be used to identify theboundaries of CDRs include, e.g., the Kabat definition, the Chothiadefinition, and the AbM definition. In general terms, the Kabatdefinition is based on sequence variability, the Chothia definition isbased on the location of the structural loop regions, and the AbMdefinition is a compromise between the Kabat and Chothia approaches.See, e.g., Kabat, “Sequences of Proteins of Immunological Interest,”National Institutes of Health, Bethesda, Md. (1991); Al-Lazikani et al.,(1997), J. Mol. Biol. 273:927-948; and Martin et al., (1989), Proc.Natl. Acad. Sci. USA 86:9268-9272. Public databases are also availablefor identifying CDR sequences within an antibody.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises a heavy chain variable region (HCVR) havingan amino acid sequence selected from the group consisting of SEQ ID NOs:2, 18, 34, 50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242,258, 274, 290, 306, 322 and 338.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises a light chain variable region (LCVR) havingan amino acid sequence selected from the group consisting of SEQ ID NOs:10, 26, 42, 58, 74, 90, 106, 122, 138, 154, 170, 186, 202, 218, 234,250, 266, 282, 298, 314, 330 and 346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises a heavy chain variable region (HCVR) havingan amino acid sequence selected from the group consisting of SEQ ID NOs:2, 18, 34, 50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242,258, 274, 290, 306, 322 and 338; and a light chain variable region(LCVR) having an amino acid sequence selected from the group consistingof SEQ ID NOs: 10, 26, 42, 58, 74, 90, 106, 122, 138, 154, 170, 186,202, 218, 234, 250, 266, 282, 298, 314, 330 and 346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises the heavy chain amino acid sequence of SEQID NO: 363 and the light chain amino acid sequence of SEQ ID NO: 364.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises a HCVR/LCVR amino acid sequence pairselected from the group consisting of SEQ ID NOs: SEQ ID NO: 2/10,18/26, 34/42, 50/58, 66/74, 82/90, 98/106, 114/122, 130/138, 146/154,162/170, 178/186, 194/202, 210/218, 226/234, 242/250, 258/266, 274/282,290/298, 306/314, 322/330 and 338/346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises a HCVR/LCVR amino acid sequence pairselected from the group consisting of SEQ ID NOs: 274/282 and 338/346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), comprises:

-   -   (a) a HCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 8, 24, 40, 56, 72, 88, 104,        120, 136, 152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312,        328, and 344; and    -   (b) a LCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 16, 32, 48, 64, 80, 96, 112,        128, 144, 160, 176, 192, 208, 224, 240, 256, 272, 288, 304, 320,        336 and 352.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F), further comprises:

(c) a HCDR1 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 4, 20, 36, 52, 68, 84, 100, 116, 132, 148,164, 180, 196, 212, 228, 244, 260, 276, 292, 308, 324 and 340;

(d) a HCDR2 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 6, 22, 38, 54, 70, 86, 102, 118, 134, 150,166, 182, 198, 214, 230, 246, 262, 278, 294, 310, 326 and 342;

(e) a LCDR1 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 12, 28, 44, 60, 76, 92, 108, 124, 140, 156,172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332 and 348; and

(f) a LCDR2 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 14, 30, 46, 62, 78, 94, 110, 126, 142, 158,174, 190, 206, 222, 238, 254, 270, 286, 302, 318, 334 and 350.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F) comprises:

-   -   (a) a HCDR1 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 4, 20, 36, 52, 68, 84, 100,        116, 132, 148, 164, 180, 196, 212, 228, 244, 260, 276, 292, 308,        324 and 340;    -   (b) a HCDR2 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 6, 22, 38, 54, 70, 86, 102,        118, 134, 150, 166, 182, 198, 214, 230, 246, 262, 278, 294, 310,        326 and 342;    -   (c) a HCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 8, 24, 40, 56, 72, 88, 104,        120, 136, 152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312,        328, and 344;    -   (4d) a LCDR1 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 12, 28, 44, 60, 76, 92, 108,        124, 140, 156, 172, 188, 204, 220, 236, 252, 268, 284, 300, 316,        332 and 348;    -   (e) a LCDR2 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 14, 30, 46, 62, 78, 94, 110,        126, 142, 158, 174, 190, 206, 222, 238, 254, 270, 286, 302, 318,        334 and 350; and    -   (f) a LCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 16, 32, 48, 64, 80, 96, 112,        128, 144, 160, 176, 192, 208, 224, 240, 256, 272, 288, 304, 320,        336 and 352.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F) comprises:

-   -   (a) a HCDR1 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 276 and 340;    -   (b) a HCDR2 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 278 and 342;    -   (c) a HCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 280 and 344;    -   (d) a LCDR1 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 284 and 348;    -   (e) a LCDR2 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 286 and 350; and    -   (f) a LCDR3 domain having an amino acid sequence selected from        the group consisting of SEQ ID NOs: 288 and 352.

In one embodiment, the isolated human antibody or antigen bindingfragment thereof that specifically binds to RSV-F comprises the HCDR1,HCDR2 and HCDR3 amino acid sequences of SEQ ID NOs: 276, 278 and 280,respectively and LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ IDNOs: 284, 286 and 288, respectively.

In one embodiment, the isolated human antibody or antigen bindingfragment thereof that specifically binds to RSV-F comprises the HCDR1,HCDR2 and HCDR3 amino acid sequences of SEQ ID NOs: 340, 342 and 344,respectively and LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ IDNOs: 348, 350 and 352, respectively.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F) competes for specific binding to RSV-F with anantibody or antigen-binding fragment comprising heavy and light chainsequence pairs selected from the group consisting of SEQ ID NOs: 2/10,18/26, 34/42, 50/58, 66/74, 82/90, 98/106, 114/122, 130/138, 146/154,162/170, 178/186, 194/202, 210/218, 226/234, 242/250, 258/266, 274/282,290/298, 306/314, 322/330 and 338/346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof, which comprises heavy and light chain sequence pairsselected from the group consisting of SEQ ID NOs: 2/10, 18/26, 34/42,50/58, 66/74, 82/90, 98/106, 114/122, 130/138, 146/154, 162/170,178/186, 194/202, 210/218, 226/234, 242/250, 258/266, 274/282, 290/298,306/314, 322/330 and 338/346, and which specifically binds toRespiratory Syncytial Virus F protein (RSV-F), does not compete forspecific binding to RSV-F with palivizumab, motavizumab, or AM-22.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof that specifically binds to Respiratory Syncytial VirusF protein (RSV-F) binds the same epitope on RSV-F that is recognized byan antibody comprising heavy and light chain sequence pairs selectedfrom the group consisting of SEQ ID NOs: 2/10, 18/26, 34/42, 50/58,66/74, 82/90, 98/106, 114/122, 130/138, 146/154, 162/170, 178/186,194/202, 210/218, 226/234, 242/250, 258/266, 274/282, 290/298, 306/314,322/330 and 338/346.

In one embodiment, the isolated human antibody or antigen-bindingfragment thereof, which comprises heavy and light chain sequence pairsselected from the group consisting of SEQ ID NOs: 2/10, 18/26, 34/42,50/58, 66/74, 82/90, 98/106, 114/122, 130/138, 146/154, 162/170,178/186, 194/202, 210/218, 226/234, 242/250, 258/266, 274/282, 290/298,306/314, 322/330 and 338/346, and which specifically binds toRespiratory Syncytial Virus F protein (RSV-F), does not bind the sameepitope on RSV-F as palivizumab or motavizumab.

In one embodiment, the invention provides a fully human monoclonalantibody or antigen-binding fragment thereof that specifically binds toRSV-F, wherein the antibody or fragment thereof exhibits one or more ofthe following characteristics: (i) comprises a HCVR having an amino acidsequence selected from the group consisting of SEQ ID NOs: 2, 18, 34,50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242, 258, 274,290, 306, 322 and 338, or a substantially similar sequence thereofhaving at least 90%, at least 95%, at least 98% or at least 99% sequenceidentity; (ii) comprises a LCVR having an amino acid sequence selectedfrom the group consisting of SEQ ID NOs: 10, 26, 42, 58, 74, 90, 106,122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298, 314, 330 and346, or a substantially similar sequence thereof having at least 90%, atleast 95%, at least 98% or at least 99% sequence identity; (iii)comprises a HCDR3 domain having an amino acid sequence selected from thegroup consisting of SEQ ID NOs: 8, 24, 40, 56, 72, 88, 104, 120, 136,152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312, 328, and 344, ora substantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; and a LCDR3 domainhaving an amino acid sequence selected from the group consisting of SEQID NO: 16, 32, 48, 64, 80, 96, 112, 128, 144, 160, 176, 192, 208, 224,240, 256, 272, 288, 304, 320, 336 and 352, or a substantially similarsequence thereof having at least 90%, at least 95%, at least 98% or atleast 99% sequence identity; (iv) comprises a HCDR1 domain having anamino acid sequence selected from the group consisting of SEQ ID NOs: 4,20, 36, 52, 68, 84, 100, 116, 132, 148, 164, 180, 196, 212, 228, 244,260, 276, 292, 308, 324 and 340, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity; (v) a HCDR2 domain having an amino acid sequenceselected from the group consisting of SEQ ID NOs: 6, 22, 38, 54, 70, 86,102, 118, 134, 150, 166, 182, 198, 214, 230, 246, 262, 278, 294, 310,326 and 342, or a substantially similar sequence thereof having at least90%, at least 95%, at least 98% or at least 99% sequence identity; (vi)a LCDR1 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 12, 28, 44, 60, 76, 92, 108, 124, 140, 156,172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332 and 348, or asubstantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; (vii) and a LCDR2domain having an amino acid sequence selected from the group consistingof SEQ ID NOs: 14, 30, 46, 62, 78, 94, 110, 126, 142, 158, 174, 190,206, 222, 238, 254, 270, 286, 302, 318, 334 and 350, or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; (viii) exhibits a K_(D) ranging fromabout 1×10⁻⁷ M to about 6×10⁻¹⁰ M as measured by surface plasmonresonance; (ix) is capable of neutralizing respiratory syncytial virussubtype A and/or subtype B strains in vitro; (x) demonstrates theability to significantly reduce the viral load in a mouse model of RSVinfection when administered at a dose ranging from about 0.05 mg/kg toabout 0.15 mg/kg; (xi) demonstrates a 1 to 2 logs greater reduction ofnasal and/or lung viral titers in a cotton rat model of RSV infection ata dose ranging from about 0.62 mg/kg to about 5.0 mg/kg when compared topalivizumab; (xii) demonstrates an effective dose 99 (ED₉₉) ranging fromabout 0.15 mg/kg to about 2.5 mg/kg when administered in an animal modelof RSV infection (e.g. a mouse model or a cotton rat model); or (xiii)demonstrates a half maximal inhibitory concentration (IC₅₀) of about 2pM to about 15 pM in a microneutralization assay specific for RSVsubtype A strains of RSV and a half maximal inhibitory concentration(IC₅₀) of about 6 pM to about 100 pM in a microneutralization assay.

In one embodiment, the invention provides a fully human monoclonalantibody or antigen-binding fragment thereof that specifically binds toRSV-F, wherein the antibody or fragment thereof exhibits one or more ofthe following characteristics: (i) comprises a HCVR having an amino acidsequence selected from the group consisting of SEQ ID NOs: 2, 18, 34,50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242, 258, 274,290, 306, 322 and 338, or a substantially similar sequence thereofhaving at least 90%, at least 95%, at least 98% or at least 99% sequenceidentity; (ii) comprises a LCVR having an amino acid sequence selectedfrom the group consisting of SEQ ID NOs: 10, 26, 42, 58, 74, 90, 106,122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298, 314, 330 and346, or a substantially similar sequence thereof having at least 90%, atleast 95%, at least 98% or at least 99% sequence identity; (iii)comprises a HCDR3 domain having an amino acid sequence selected from thegroup consisting of SEQ ID NOs: 8, 24, 40, 56, 72, 88, 104, 120, 136,152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312, 328, and 344, ora substantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; and a LCDR3 domainhaving an amino acid sequence selected from the group consisting of SEQID NO: 16, 32, 48, 64, 80, 96, 112, 128, 144, 160, 176, 192, 208, 224,240, 256, 272, 288, 304, 320, 336 and 352, or a substantially similarsequence thereof having at least 90%, at least 95%, at least 98% or atleast 99% sequence identity; (iv) comprises a HCDR1 domain having anamino acid sequence selected from the group consisting of SEQ ID NOs: 4,20, 36, 52, 68, 84, 100, 116, 132, 148, 164, 180, 196, 212, 228, 244,260, 276, 292, 308, 324 and 340, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity; (v) a HCDR2 domain having an amino acid sequenceselected from the group consisting of SEQ ID NOs: 6, 22, 38, 54, 70, 86,102, 118, 134, 150, 166, 182, 198, 214, 230, 246, 262, 278, 294, 310,326 and 342, or a substantially similar sequence thereof having at least90%, at least 95%, at least 98% or at least 99% sequence identity; (vi)a LCDR1 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 12, 28, 44, 60, 76, 92, 108, 124, 140, 156,172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332 and 348, or asubstantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; (vii) and a LCDR2domain having an amino acid sequence selected from the group consistingof SEQ ID NOs: 14, 30, 46, 62, 78, 94, 110, 126, 142, 158, 174, 190,206, 222, 238, 254, 270, 286, 302, 318, 334 and 350, or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; (viii) exhibits a K_(D) ranging fromabout 1×10⁻⁷ M to about 6×10⁻¹⁰ M; (ix) is capable of neutralizingrespiratory syncytial virus subtype A and/or subtype B strains in vitro;(x) demonstrates the ability to significantly reduce the viral load inan animal model of RSV infection (e.g. a mouse model) when administeredat a dose ranging from about 0.05 mg/kg to about 0.15 mg/kg; (xi)demonstrates a 1 to 2 logs greater reduction of nasal and/or lung viraltiters in an animal model of RSV infection (e.g. a cotton rat model) ata dose ranging from about 0.62 mg/kg to about 5.0 mg/kg when compared topalivizumab; (xii) demonstrates an effective dose 99 (ED₉₉) ranging fromabout 0.05 mg/kg to about 2.5 mg/kg when administered in an animal modelof RSV infection (e.g. a mouse model or a cotton rat model); (xiii)demonstrates an ED₉₉ that is about 2 to 3 fold lower than the ED₉₉ forpalivizumab or motavizumab; (xiv) demonstrates a neutralization potencyagainst one or more subtype A laboratory strains of RSV that is about 15to 17 fold improvement over palivizumab, or demonstrates aneutralization potency against one or more subtype A clinical strains ofRSV that is about a 10-22 fold improvement over palivizumab; (xv)demonstrates a neutralization potency against one or more subtype Blaboratory strains of RSV that is about a 2 to 5 fold improvement overpalivizumab; (xvi) demonstrates a neutralization potency against one ormore subtype A laboratory strains or subtype A clinical strains of RSVthat is about 0.5 to 2 fold improvement over AM-22; (xvii) demonstratesa neutralization potency against one or more subtype B laboratorystrains of RSV that is about a 2.5 to 17 fold improvement over AM-22.

In one embodiment, the invention provides a fully human monoclonalantibody or antigen-binding fragment thereof that specifically binds toRSV-F, wherein the antibody or fragment thereof exhibits one or more ofthe following characteristics: (i) comprises a HCVR having an amino acidsequence selected from the group consisting of SEQ ID NOs: 2, 18, 34,50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242, 258, 274,290, 306, 322 and 338, or a substantially similar sequence thereofhaving at least 90%, at least 95%, at least 98% or at least 99% sequenceidentity; (ii) comprises a LCVR having an amino acid sequence selectedfrom the group consisting of SEQ ID NOs: 10, 26, 42, 58, 74, 90, 106,122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298, 314, 330 and346, or a substantially similar sequence thereof having at least 90%, atleast 95%, at least 98% or at least 99% sequence identity; (iii)comprises a HCDR3 domain having an amino acid sequence selected from thegroup consisting of SEQ ID NOs: 8, 24, 40, 56, 72, 88, 104, 120, 136,152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312, 328, and 344, ora substantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; and a LCDR3 domainhaving an amino acid sequence selected from the group consisting of SEQID NO: 16, 32, 48, 64, 80, 96, 112, 128, 144, 160, 176, 192, 208, 224,240, 256, 272, 288, 304, 320, 336 and 352, or a substantially similarsequence thereof having at least 90%, at least 95%, at least 98% or atleast 99% sequence identity; (iv) comprises a HCDR1 domain having anamino acid sequence selected from the group consisting of SEQ ID NOs: 4,20, 36, 52, 68, 84, 100, 116, 132, 148, 164, 180, 196, 212, 228, 244,260, 276, 292, 308, 324 and 340, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity; (v) a HCDR2 domain having an amino acid sequenceselected from the group consisting of SEQ ID NOs: 6, 22, 38, 54, 70, 86,102, 118, 134, 150, 166, 182, 198, 214, 230, 246, 262, 278, 294, 310,326 and 342, or a substantially similar sequence thereof having at least90%, at least 95%, at least 98% or at least 99% sequence identity; (vi)a LCDR1 domain having an amino acid sequence selected from the groupconsisting of SEQ ID NOs: 12, 28, 44, 60, 76, 92, 108, 124, 140, 156,172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332 and 348, or asubstantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; (vii) and a LCDR2domain having an amino acid sequence selected from the group consistingof SEQ ID NOs: 14, 30, 46, 62, 78, 94, 110, 126, 142, 158, 174, 190,206, 222, 238, 254, 270, 286, 302, 318, 334 and 350, or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; (viii) exhibits a K_(D) ranging fromabout 1×10⁻⁷ M to about 6×10⁻¹⁰ M; (ix) is capable of neutralizingrespiratory syncytial virus subtype A and/or subtype B strains in vitro;(x) demonstrates the ability to significantly reduce the viral load inan mammal having an RSV infection; (xi) interacts with an amino acidsequence comprising amino acid residues ranging from about position 161to about position 188 of SEQ ID NO: 354; (xii) interacts with either theserine at position 173 of SEQ ID O: 354, or the threonine at position174 of SEQ ID NO: 354, or both the serine at position 173 of SEQ ID O:354, and the threonine at position 174 of SEQ ID NO: 354; (xiii)inhibits fusion of RSV to the host cell; (xiv) does not cross-competewith palivizumab or AM-22 for binding to RSV-F.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds Respiratory Syncytial Virus F protein(RSV-F), or an antigen-binding fragment thereof, wherein the antibody orantigen-binding fragment thereof interacts with an amino acid sequencecomprising amino acid residues ranging from about position 161 to aboutposition 188 of SEQ ID NO: 354.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid sequence selected from the groupconsisting of SEQ ID NO: 355 and 356.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid residue within residues 161through 188 of SEQ ID NO: 354.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid residue within SEQ ID NO: 355 orSEQ ID NO:356.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with either the serine at position 173 of SEQ ID NO: 354, orthe threonine at position 174 of SEQ ID NO: 354, or both the serine atposition 173 of SEQ ID NO: 354 and the threonine at position 174 of SEQID NO: 354.

In one embodiment, the invention provides an isolated human monoclonalantibody or antigen-binding fragment thereof that specifically binds toRespiratory Syncytial Virus F protein (RSV-F), wherein the antibody orantigen-binding fragment thereof interacts with an amino acid sequencecomprising amino acid residues ranging from about position 161 to aboutposition 188 of SEQ ID NO: 354, and wherein the antibody orantigen-binding fragment thereof comprises three heavy chain CDRs(HCDR1, HCDR2 and HCDR3) contained within the heavy chain variableregion (HCVR) amino acid sequence of SEQ ID NO: 274; and three lightchain CDRs (LCDR1, LCDR2 and LCDR3) contained within the light chainvariable region (LCVR) amino acid sequence of SEQ ID NO: 282.

In one embodiment, the invention provides an isolated human monoclonalantibody or antigen-binding fragment thereof that specifically binds toRespiratory Syncytial Virus F protein (RSV-F), wherein the antibody orantigen-binding fragment thereof comprises:

-   -   (a) a HCDR1 domain comprising the amino acid sequence of SEQ ID        NO: 276;    -   (b) a HCDR2 domain comprising the amino acid sequence of SEQ ID        NO: 278;    -   (c) a HCDR3 domain comprising the amino acid sequence of SEQ ID        NO: 280;    -   (d) a LCDR1 domain comprising the amino acid sequence of SEQ ID        NO: 284;    -   (e) a LCDR2 domain comprising the amino acid sequence of SEQ ID        NO: 286; and    -   (f) a LCDR3 domain comprising the amino acid sequence of SEQ ID        NO: 288.

In one embodiment, the invention provides an isolated human monoclonalantibody, or an antigen-binding fragment thereof, that bindsspecifically to RSV-F, wherein the antibody comprises the three HCDRscontained within the heavy chain variable region (HCVR) amino acidsequence of SEQ ID NO: 274; and the three light chain CDRs (LCDR1, LCDR2and LCDR3) contained within the light chain variable region (LCVR) aminoacid sequence of SEQ ID NO: 282 and wherein the antibody orantigen-binding fragment thereof interacts with at least one amino acidsequence selected from the group consisting of SEQ ID NO: 355 and 356.

In one embodiment, the invention provides an isolated human monoclonalantibody, or an antigen-binding fragment thereof, that bindsspecifically to RSV-F, wherein the antibody comprises the three HCDRscontained within the heavy chain variable region (HCVR) amino acidsequence of SEQ ID NO: 274; and the three light chain CDRs (LCDR1, LCDR2and LCDR3) contained within the light chain variable region (LCVR) aminoacid sequence of SEQ ID NO: 282 and wherein the antibody orantigen-binding fragment thereof interacts with at least one amino acidresidue within residues 161 through 188 of SEQ ID NO: 354.

In one embodiment, the invention provides an isolated human monoclonalantibody, or an antigen-binding fragment thereof, that bindsspecifically to RSV-F, wherein the antibody comprises the three HCDRscontained within the heavy chain variable region (HCVR) amino acidsequence of SEQ ID NO: 274; and the three light chain CDRs (LCDR1, LCDR2and LCDR3) contained within the light chain variable region (LCVR) aminoacid sequence of SEQ ID NO: 282 and wherein the antibody orantigen-binding fragment thereof interacts with at least one amino acidresidue within SEQ ID NO: 355 or SEQ ID NO:356.

In one embodiment, the invention provides an isolated human monoclonalantibody, or an antigen-binding fragment thereof, that bindsspecifically to RSV-F, wherein the antibody comprises the three HCDRscontained within the heavy chain variable region (HCVR) amino acidsequence of SEQ ID NO: 274; and the three light chain CDRs (LCDR1, LCDR2and LCDR3) contained within the light chain variable region (LCVR) aminoacid sequence of SEQ ID NO: 282, wherein the antibody or antigen-bindingfragment thereof interacts with either the serine at position 173 of SEQID NO: 354, or the threonine at position 174 of SEQ ID NO: 354, or boththe serine at position 173 of SEQ ID NO: 354 and the threonine atposition 174 of SEQ ID NO: 354.

In one embodiment, the invention provides an isolated human antibody, oran antigen-binding fragment thereof that does not cross-compete forbinding to RSV-F with palivizumab, or motavizumab.

In one embodiment, the invention provides an isolated human antibody, oran antigen-binding fragment thereof that does not cross-compete forbinding to RSV-F with AM-22.

In one embodiment, the invention provides an isolated human antibody, oran antigen-binding fragment thereof that does not bind the same epitopeon RSV-F as palivizumab.

In one embodiment, the invention provides an isolated human antibody, oran antigen-binding fragment thereof that does not bind the same epitopeon RSV-F as motavizumab.

In one embodiment, the invention provides an isolated human monoclonalantibody, or an antigen-binding fragment thereof that does not bind toan epitope on RSV-F ranging from about amino acid residue 255 to aboutamino acid residue 276 of SEQ ID NO: 354.

In one embodiment, the isolated human monoclonal antibody, or anantigen-binding fragment thereof does not bind to the same epitope onRSV-F as palivizumab, wherein the epitope ranges from about amino acidresidue 255 to about amino acid residue 276 of SEQ ID NO: 354.

In a second aspect, the invention provides nucleic acid moleculesencoding antibodies or fragments thereof that specifically bind toRSV-F. Recombinant expression vectors carrying the nucleic acids of theinvention, and host cells into which such vectors have been introduced,are also encompassed by the invention, as are methods of producing theantibodies by culturing the host cells under conditions permittingproduction of the antibodies, and recovering the antibodies produced.

In one embodiment, the invention provides an antibody or fragmentthereof comprising a HCVR encoded by a nucleic acid sequence selectedfrom the group consisting of SEQ ID NO: 1, 17, 33,49, 65, 81, 97, 113,129, 145, 161, 177, 193, 209, 225, 241, 257, 273, 289, 305, 321, and 337or a substantially identical sequence having at least 90%, at least 95%,at least 98%, or at least 99% homology thereof.

In one embodiment, the HCVR is encoded by a nucleic acid sequenceselected from the group consisting of SEQ ID NO: 273 and 337.

In one embodiment, the antibody or fragment thereof further comprises aLCVR encoded by a nucleic acid sequence selected from the groupconsisting of SEQ ID NO: 9, 25, 41, 57, 73, 89, 105, 121, 137, 153, 169,185, 201, 217, 233, 249, 265, 281, 297, 313, 329, and 345, or asubstantially identical sequence having at least 90%, at least 95%, atleast 98%, or at least 99% homology thereof.

In one embodiment, the LCVR is encoded by a nucleic acid sequenceselected from the group consisting of SEQ ID NO: 281 and 345.

In one embodiment, the invention also provides an antibody orantigen-binding fragment of an antibody comprising a HCDR3 domainencoded by a nucleotide sequence selected from the group consisting ofSEQ ID NO: 7, 23, 39, 55, 71, 87, 103, 119, 135, 151, 167, 183, 199,215, 231, 247, 263, 279, 295, 311, 327, and 343 or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; and a LCDR3 domain encoded by anucleotide sequence selected from the group consisting of SEQ ID NO: 15,31, 47, 63, 79, 95, 111, 127, 143, 159, 175, 191, 207, 223, 239, 255,271, 287, 303, 319, 335, and 351, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity.

In one embodiment, the invention provides an antibody or fragmentthereof further comprising a HCDR1 domain encoded by a nucleotidesequence selected from the group consisting of SEQ ID NO: 3, 19, 35, 51,67, 83, 99, 115, 131, 147, 163, 179, 195, 211, 227, 243, 259, 275, 291,307, 323, and 339, or a substantially similar sequence thereof having atleast 90%, at least 95%, at least 98% or at least 99% sequence identity;a HCDR2 domain encoded by a nucleotide sequence selected from the groupconsisting of SEQ ID NO: 5, 21, 37, 53, 69, 85, 101, 117, 133, 149, 165,181, 197, 213, 229, 245, 261, 277, 293, 309, 325, and 341, or asubstantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity; a LCDR1 domainencoded by a nucleotide sequence selected from the group consisting ofSEQ ID NO: 11, 27, 43, 59, 75, 91, 107, 123, 139, 155, 171, 187, 203,219, 235, 251, 267, 283, 299, 315, 331, and 347, or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; and a LCDR2 domain encoded by anucleotide sequence selected from the group consisting of SEQ ID NO: 13,29, 45, 61, 77, 93, 109, 125, 141, 157, 173, 189, 205, 221, 237, 253,269, 285, 301, 317, 333, and 349, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity.

In a third aspect, the invention features a human antibody orantigen-binding fragment specific for RSV-F comprising a HCVR encoded bynucleotide sequence segments derived from V_(H), D_(H) and J_(H)germline sequences, and a LCVR encoded by nucleotide sequence segmentsderived from V_(K) and J_(K) germline sequences.

The invention encompasses antibodies having a modified glycosylationpattern. In some applications, modification to remove undesirableglycosylation sites may be useful, or e.g., removal of a fucose moietyto increase antibody dependent cellular cytotoxicity (ADCC) function(see Shield et al. (2002) JBC 277:26733). In other applications,modification of galactosylation can be made in order to modifycomplement dependent cytotoxicity (CDC).

In a fourth aspect, the invention provides a pharmaceutical compositioncomprising at least one isolated fully human monoclonal antibody orantigen-binding fragment thereof that binds to RSV-F and apharmaceutically acceptable carrier or diluent. In one embodiment, theinvention provides a pharmaceutical composition comprising two fullyhuman monoclonal antibodies or antigen-binding fragments thereof, whicheither bind to the same epitope or bind to two different epitopes onRSV-F and a pharmaceutically acceptable carrier or diluent. It is to beunderstood that any combination of antibodies as described herein may beused in a pharmaceutical composition to achieve the desired results inthe patient population in need of such therapy. For example, twoantibodies that recognize and/or bind RSV-F may be used in acomposition. Alternatively, two antibodies, one that recognizes and/orbinds RSV-F and a second antibody that binds to another antigen on RSV(e.g. RSV-G) may be used in a composition. In one embodiment, twoantibodies, one that recognizes and/or binds RSV-F and a second antibodythat binds to a metapneumovirus antigen may be used in a composition.Alternatively, two or more antibodies may be used in a composition, onethat recognizes and/or binds to RSV-F, one that binds to ametapneumovirus antigen and one that binds to an influenza virus antigenor to any other virus that causes respiratory diseases.

In one embodiment, the pharmaceutical composition comprises an antibodythat binds RSV-F and has a HCVR/LCVR amino acid sequence pair selectedfrom the group consisting of SEQ ID NOs: 274/282 and 338/346.

In one embodiment, the pharmaceutical composition comprises an antibodythat binds RSV-F and has a HCVR/LCVR amino acid sequence pair consistingof SEQ ID NOs: 274/282.

In one embodiment, the pharmaceutical composition comprises an antibodythat binds RSV-F and has a HCVR/LCVR amino acid sequence pair consistingof SEQ ID NOs: 338/346.

In one embodiment, the pharmaceutical composition comprises at least oneantibody that binds RSV-F, wherein the antibody comprises the threeheavy chain complementarity determining regions (HCDR1, HCDR2 and HCDR3)contained within any one of the heavy chain variable region (HCVR) aminoacid sequences selected from the group consisting of SEQ ID NOs: 274 and338; and the three light chain complementarity determining regions(LCDR1, LCDR2 and LCDR3) contained within any one of the light chainvariable region (LCVR) amino acid sequences selected from the groupconsisting of SEQ ID NOs: 282 and 346.

In one embodiment, the antibodies of the invention, or compositionscontaining one or more antibodies of the invention may be used toneutralize RSV from any subtype A or subtype B strain of RSV.

In one embodiment, the invention features a composition, which is acombination of an antibody or antigen-binding fragment of an antibody ofthe invention, and a second therapeutic agent.

The second therapeutic agent may be a small molecule drug, aprotein/polypeptide, an antibody, a nucleic acid molecule, such as ananti-sense molecule, or a siRNA. The second therapeutic agent may besynthetic or naturally derived.

The second therapeutic agent may be any agent that is advantageouslycombined with the antibody or fragment thereof of the invention, forexample, an antiviral agent (e.g. ribavirin), a vaccine specific forRSV, or a vaccine specific for influenza virus, or a vaccine specificfor metapneumovirus (MPV), an siRNA specific for an RSV antigen, ansiRNA specific for an influenza virus antigen, an siRNA specific for ametapneumovirus (MPV) antigen, a second antibody specific for an RSVantigen, or a metapneumovirus (MPV) antigen, or an influenza antigen, ananti-IL4R antibody, an anti-RSV-G antibody or a NSAID. In certainembodiments, the second therapeutic agent may be an agent that helps tocounteract or reduce any possible side effect(s) associated with theantibody or antigen-binding fragment of an antibody of the invention, ifsuch side effect(s) should occur.

It will also be appreciated that the antibodies and pharmaceuticallyacceptable compositions of the present invention can be employed incombination therapies, that is, the antibodies and pharmaceuticallyacceptable compositions can be administered concurrently with, prior to,or subsequent to, one or more other desired therapeutics or medicalprocedures. The particular combination of therapies (therapeutics orprocedures) to employ in a combination regimen will take into accountcompatibility of the desired therapeutics and/or procedures and thedesired therapeutic effect to be achieved. It will also be appreciatedthat the therapies employed may achieve a desired effect for the samedisorder (for example, an antibody may be administered concurrently withanother agent used to treat the same disorder), or they may achievedifferent effects (e.g., control of any adverse effects). As usedherein, additional therapeutic agents that are normally administered totreat or prevent a particular disease, or condition, are appropriate forthe disease, or condition, being treated.

When multiple therapeutics are co-administered, dosages may be adjustedaccordingly, as is recognized in the pertinent art.

A fifth aspect of the invention provides a method for preventinginfection with respiratory syncytial virus in a patient in need thereof,or for treating a patient suffering from an infection with RSV, or forameliorating at least one symptom or complication associated with theRSV infection, the method comprising administering one or moreantibodies or antigen-binding fragments thereof as described herein, ora pharmaceutical composition comprising one or more antibodies of theinvention or fragments thereof, as described herein, to a patient inneed thereof, such that the RSV infection is prevented, or at least onesymptom or complication associated with the infection is ameliorated,alleviated or reduced in severity and/or duration.

In a related embodiment, the invention provides a pharmaceuticalcomposition comprising one or more antibodies of the invention, alone orin combination with a second therapeutic agent, for use in preventing arespiratory syncytial virus (RSV) infection in a patient in needthereof, or for treating a patient suffering from an RSV infection, orfor ameliorating at least one symptom or complication associated withthe infection, wherein the infection is either prevented, or at leastone symptom or complication associated with the infection is prevented,ameliorated, or lessened in severity and/or duration.

In one embodiment, the invention provides a pharmaceutical compositioncomprising one or more antibodies of the invention, alone or incombination with a second therapeutic agent in the manufacture of amedicament for preventing a respiratory syncytial virus (RSV) infectionin a patient in need thereof, or for treating a patient suffering froman RSV infection, or for ameliorating at least one symptom orcomplication associated with the infection, wherein the infection iseither prevented, or at least one symptom or complication associatedwith the infection is prevented, ameliorated, or lessened in severityand/or duration.

In one embodiment, a patient in need of treatment with an antibody ofthe invention, or an antigen-binding fragment thereof is a patient whomay experience a more severe form of the RSV infection due to anunderlying or pre-existing medical condition. In one embodiment, themethod provides for preventing the development of infection with RSV ina patient at risk thereof, the method comprising administering to thepatient an effective amount of an antibody or an antigen-bindingfragment thereof that binds to the F protein of RSV, or a pharmaceuticalcomposition comprising an effective amount of an antibody or anantigen-binding fragment thereof that binds to the F protein of RSV suchthat the infection is either prevented, ameliorated, or lessened inseverity and/or duration, or at least one symptom or complicationassociated with the infection is prevented, or ameliorated, or lessenedin severity or duration. In one embodiment, the administering of theisolated human RSV-F antibody or an antigen-binding fragment thereofresults in prevention of recurrent wheezing in the patient. In oneembodiment, the administering of the isolated human RSV-F antibody or anantigen-binding fragment thereof results in prevention of RSV-associatedasthma in a child. In one embodiment, the administering of the isolatedhuman RSV-F antibody or an antigen-binding fragment thereof results inprevention of an RSV infection caused by a subtype A or a subtype Brespiratory syncytial virus.

In one embodiment, the at least one symptom or complication associatedwith the RSV infection that may be treated with an antibody of theinvention, or an antigen-binding fragment thereof, may be selected fromthe group consisting of hypoxia, a bluish skin color due to lack ofoxygen, breathing difficulty (e.g.,rapid breathing or shortness ofbreath), cough, croupy cough (“seal bark” cough), fever, nasal flaring,stuffy nose, wheezing, pneumonia, apnea, dehydration, poor feeding,altered mental status, decreased appetite, or bronchiolitis.

In one embodiment, the patient at risk of developing an RSV infection,who may benefit from treatment with the antibodies of the invention, orwith a composition comprising one or more antibodies of the invention,may be selected from the group consisting of a pre-term infant, a fullterm infant who is compromised due to some other underlying medicalcondition and/or is exposed during the peak season for RSV, a childgreater than or equal to one year of age with or without an underlyingmedical condition (e.g. congenital heart disease, chronic lung disease,cystic fibrosis, immunodeficiency, a neuromuscular disorder), aninstitutionalized or hospitalized patient, an elderly patient (≥65 yearsof age) with or without an underlying medical condition such ascongestive heart failure or chronic obstructive pulmonary disease), apatient who is immunocompromised due to underlying illness or due toadministration of immunosuppressive therapeutics, a patient who has someunderlying medical condition that may pre-dispose them to acquiring anRSV infection, for example, chronic obstructive pulmonary disease(COPD), congestive heart failure, cystic fibrosis, bronchopulmonarydysplasia, airway malfunction, chronic lung disease, a cancer patient,or a transplant patient who is on immunosuppressive therapy.

In one embodiment, a patient who is a candidate for therapy with anantibody of the invention may suffer from a condition resulting from acompromised pulmonary, cardiovascular, neuromuscular, or immune system.The condition may be selected from the group consisting of anabnormality of the airway, a chronic lung disease, a chronic heartdisease, a neuromuscular disease that compromises the handling ofrespiratory secretions and immunosuppression. The chronic lung diseasemay be chronic obstructive pulmonary disease (COPD), cystic fibrosis, orbronchopulmonary dysplasia. The chronic heart disease may be congestiveheart failure (CHF), or congenital heart disease. The neuromusculardisease or condition may be a neurodegenerative disease, or an inabilityto handle and/or eliminate respiratory secretions due to an injury oraccident to the nervous system, e.g. a stroke, or a spinal cord injury.The immunosuppression may be the result of severe combinedimmunodeficiency or severe acquired immunodeficiency, or may be a resultof any other infectious disease or cancerous condition that leads toimmunosuppression, or is a result of treatment with immunosuppressantdrug therapy or radiation therapy.

In one embodiment, the antibody is administered prophylactically(administered prior to development of the infection) to a patient atrisk for developing an RSV infection, or at risk for developing at leastone symptom or complication associated with the RSV infection. Thepatients who are candidates for treatment with the antibodies of theinvention may be administered the compositions comprising one or moreantibodies by any route of delivery suitable for administration,including but not limited to intravenous injection, intramuscularinjection, or subcutaneous injection.

In one embodiment, the antibody is administered therapeutically(administered after the development of the infection) to a patient toameliorate or reduce the severity and/or duration of at least onesymptom or complication associated with the RSV infection.

In one embodiment, the antibodies of the invention may be administeredto the patient in combination with one or more therapeutic agents usefulfor treating a RSV infection. The one or more therapeutic agents may beselected from the group consisting of an antiviral agent; a vaccinespecific for RSV, a vaccine specific for influenza virus, or a vaccinespecific for metapneumovirus (MPV); an siRNA specific for an RSV antigenor a metapneumovirus (MPV) antigen; a second antibody specific for anRSV antigen or a metapneumovirus (MPV) antigen; an anti-IL4R antibody,an antibody specific for an influenza virus antigen, an anti-RSV-Gantibody and a NSAID.

A sixth aspect of the invention provides an immunogenic composition, ora vaccine, that when administered to an individual, preferably a human,induces an immune response in such individual to a Respiratory SyncytialVirus (RSV) antigen.

In one embodiment, the immunogenic composition, or vaccine, comprises anRSV antigen, for example, an RSV-F protein, polypeptide, or animmunogenic fragment thereof, or an epitope contained within and/orobtained from an antigen of the RSV-F polypeptide or a fragment thereof,and/or comprises DNA and/or RNA which encodes and expresses an epitopefrom an antigen of the RSV-F polypeptide, or other polypeptides of theinvention.

In one embodiment of the invention, the immunogenic composition, orvaccine, may comprise the RSV-F protein as shown in SEQ ID NO: 354. Inone embodiment of the invention, the immunogenic composition, orvaccine, may comprise a RSV-F polypeptide fragment comprising residues161 through 188 of SEQ ID NO: 354. In one embodiment of the invention,the immunogenic composition, or vaccine, may comprise one or more aminoacid residues contained within SEQ ID NO: 355 and/or SEQ ID NO: 356. Inone embodiment of the invention, the immunogenic composition, orvaccine, may comprise SEQ ID NO: 355 and/or SEQ ID NO: 356.

In a related aspect, the invention provides a method for inducing animmune response in an individual, particularly a mammal, preferablyhumans, by administering to an individual an immunogenic composition, ora vaccine, comprising a RSV-F protein, or an immunogenic fragmentthereof, or a RSV-F antigen or an immunogenic fragment thereofcomprising one or more epitopes contained within the RSV-F antigen orfragment thereof, adequate to produce an antibody and/or a T cell immuneresponse to protect the individual from infection, particularlyinfection with Respiratory Syncytial Virus (RSV).

In one embodiment, methods are provided for using the immunogeniccompositions, or vaccines of the invention for inducing an immuneresponse that results in inhibiting, or slowing the progression of cellto cell viral spread. Methods are also provided for ameliorating atleast one symptom associated with RSV infection by administering animmunogenic composition, or a vaccine, comprising at least one RSV-Fantigen, or one or more epitopes contained within the RSV-F antigen,which when administered will induce an immune response in theindividual.

For example, in one embodiment the invention provides a method ofinducing an immune response in an individual comprising delivering tothe individual an immunogenic composition, or vaccine comprising, anRSV-F antigen (e.g. the amino acid sequence shown in SEQ ID NO: 354), oran antigenic fragment thereof, (e.g. a polypeptide comprising residues161 through 188 of SEQ ID NO: 354), or a nucleic acid vector comprisinga nucleotide sequence to direct expression of such viral polypeptide, ora fragment or a variant thereof, in vivo in order to induce an immuneresponse.

In one embodiment of the invention, the polypeptide to be used in animmunogenic composition or in a vaccine for inducing an immune responsein an individual comprises residues 161 through 188 of SEQ ID NO: 354.In one embodiment of the invention, the polypeptide to be used in animmunogenic composition or in a vaccine for inducing an immune responsein an individual comprises one or more amino acid residues containedwithin SEQ ID NO: 355 and/or SEQ ID NO: 356. In one embodiment of theinvention, the polypeptide to be used in an immunogenic composition orin a vaccine for inducing an immune response in an individual comprisesSEQ ID NO: 355 and/or SEQ ID NO: 356. In one embodiment of theinvention, the immunogenic composition, or vaccine, may elicit anantibody response or a T cell response specific for the RSV-F antigen ofRSV, wherein the antibodies generated interact with either the serine atposition 173 of SEQ ID NO: 354, or the threonine at position 354, orboth the serine at position 173 of SEQ ID NO: 354 and the threonine atposition 174 of SEQ ID NO: 354.

In certain embodiments of the invention, the immunogenic composition, orvaccine may comprise an immunogenic polypeptide and/or polynucleotide ofthe invention, or a combination thereof, together with a suitablecarrier/excipient, such as a pharmaceutically acceptablecarrier/excipient. The immunogenic composition, or vaccine of theinvention may also include adjuvants for enhancing the immunogenicity ofthe formulation.

In certain embodiments, it is advantageous for the RSV-F antigens orfragments thereof to be formulated into immunogenic compositions, orvaccines that comprise immunogenic, preferably immunologicallyeffective, amounts of additional antigens to elicit immunity to otherpathogens, preferably viruses and/or bacteria. Such additional antigensmay include an influenza virus antigen, an antigen from metapneumovirusor from a coronavirus, an antigen from Haemophilus influenzae,Streptococcus pneumonia, or Bordetella pertussis. Other RSV antigens maybe included in the immunogenic compositions, or vaccines, such as theRSV-G glycoprotein, or immunogenic fragments thereof, the HN protein, orderivatives thereof.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a schematic diagram of the RSV-F protein.

FIGS. 2A and 2B show that H1H3592P3 blocks viral entry by inhibitingfusion of virus and cell membranes.

DETAILED DESCRIPTION

Before the present methods are described, it is to be understood thatthis invention is not limited to particular methods, and experimentalconditions described, as such methods and conditions may vary. It isalso to be understood that the terminology used herein is for thepurpose of describing particular embodiments only, and is not intendedto be limiting, since the scope of the present invention will be limitedonly by the appended claims.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. As used herein, the term“about,” when used in reference to a particular recited numerical value,means that the value may vary from the recited value by no more than 1%.For example, as used herein, the expression “about 100” includes 99 and101 and all values in between (e.g., 99.1, 99.2, 99.3, 99.4, etc.).

Although any methods and materials similar or equivalent to thosedescribed herein can be used in the practice or testing of the presentinvention, preferred methods and materials are now described. Allpublications mentioned herein are incorporated herein by reference intheir entirety.

Definitions

“Respiratory Syncytial Virus-F protein”, also referred to as “RSV-F” isa type I transmembrane surface protein, which has an N terminal cleavedsignal peptide and a membrane anchor near the C terminus (Collins, P. L.et al., (1984), PNAS (USA) 81:7683-7687). The RSV-F protein issynthesized as an inactive 67 KDa precursor denoted as F0 (Calder, L.J.; et al., Virology (2000), 271, 122-131. The F0 protein is activatedproteolytically in the Golgi complex by a furin-like protease at twosites, yielding two disulfide linked polypeptides, F2 and F1, from the Nand C terminal, respectively. There is a 27 amino acid peptide releasedcalled “pep27”. There are furin cleavage sites (FCS) on either side ofthe pep27 (Collins, P. L.; Mottet, G. (1991), J. Gen. ViroL, 72:3095-3101; Sugrue, R. J, et al. (2001), J. Gen. ViroL, 82,1375-1386).The F2 subunit consists of the Heptad repeat C (HRC), while the F1contains the fusion polypeptide (FP), heptad repeat A (HRA), domain I,domain II, heptad repeat B (HRB), transmembrane (TM) and cytoplasmicdomain (CP) (See Sun, Z. et al. Viruses (2013), 5:211-225). The RSV-Fprotein plays a role in fusion of the virus particle to the cellmembrane, and is expressed on the surface of infected cells, thusplaying a role in cell to cell transmission of the virus and syncytiaformation. The amino acid sequence of the RSV-F protein is provided inGenBank as accession number AAX23994 and is also referred to herein asSEQ ID NO: 354.

A genetically engineered construct of the RSV-F protein is shown hereinas having the amino acid sequence of SEQ ID NO: 353.

The term “laboratory strain” as used herein refers to a strain of RSV(subtype A or B) that has been passaged extensively in in vitro cellculture. A “laboratory strain” can acquire adaptive mutations that mayaffect their biological properties. A “clinical strain” as used hereinrefers to an RSV isolate (subtype A or B), which is obtained from aninfected individual and which has been isolated and grown in tissueculture at low passage.

The term “effective dose 99” or “ED₉₉” refers to the dosage of an agentthat produces a desired effect of 99% reduction of viral forming plaquesrelative to the isotype (negative) control. In the present invention,the ED₉₉ refers to the dosage of the anti-RSV-F antibodies that willneutralize the virus infection (ie.g. reduce 99% of viral load) in vivo,as described in Example 5.

The term “IC50” refers to the “half maximal inhibitory concentration”,which value measures the effectiveness of compound (e.g. anti-RSV-Fantibody) inhibition towards a biological or biochemical utility. Thisquantitative measure indicates the quantity required for a particularinhibitor to inhibit a given biological process by half.

“Palivizumab”, also referred to as “SYNAGIS®”, is a humanized anti-RSV-Fantibody with heavy and light chain variable domains having the aminoacid sequences as set forth in U.S. Pat. No. 7,635,568 and 5,824,307(also shown herein as SEQ ID NO: 361 for the heavy chain of the antibodyand SEQ ID NO: 362 for the light chain of the antibody). This antibody,which immunospecifically binds to the RSV-F protein, is currentlyFDA-approved for the passive immunoprophylaxis of serious RSV disease inhigh-risk children and is administered intramuscularly at recommendedmonthly doses of 15 mg/kg of body weight throughout the RSV season(November through April in the northern hemisphere). SYNAGIS® iscomposed of 95% human and 5% murine antibody sequences. See also Johnsonet al., (1997), J. Infect. Diseases 176:1215-1224.

“Motavizumab”, also referred to as “NUMAX™”, is an enhanced potencyRSV-F-specific humanized monoclonal antibody derived by in vitroaffinity maturation of the complementarity-determining regions of theheavy and light chains of palivizumab. For reference purposes, the aminoacid sequence of the NUMAX™ antibody is disclosed in U.S PatentPublication 2003/0091584 and in U.S. Pat. No. 6,818,216 and in Wu etal., (2005) J. Mol. Bio. 350(1):126-144 and in Wu, et al. (2007) J. Mol.Biol. 368:652-665. It is also shown herein as SEQ ID NO: 359 for theheavy chain and as SEQ ID NO: 360 for the light chain of the antibody.

As used herein, the terms “treat,” “treatment” and “treating” refer tothe reduction or amelioration of the progression, severity, and/orduration of an upper and/or lower respiratory tract RSV infection,otitis media, or a symptom or respiratory condition related thereto(such as asthma, wheezing, or a combination thereof) resulting from theadministration of one or more therapies (including, but not limited to,the administration of one or more prophylactic or therapeutic agents).In specific embodiments, such terms refer to the reduction or inhibitionof the replication of RSV, the inhibition or reduction in the spread ofRSV to other tissues or subjects (e.g., the spread to the lowerrespiratory tract), the inhibition or reduction of infection of a cellwith a RSV, or the amelioration of one or more symptoms associated withan upper and/or lower respiratory tract RSV infection or otitis media.

As used herein, the terms “prevent,” “preventing,” and “prevention”refer to the prevention or inhibition of the development or onset of anupper and/or lower respiratory tract RSV infection, otitis media or arespiratory condition related thereto in a subject, the prevention orinhibition of the progression of an upper respiratory tract RSVinfection to a lower respiratory tract RSV infection, otitis media or arespiratory condition related thereto resulting from the administrationof a therapy (e.g., a prophylactic or therapeutic agent), the preventionof a symptom of an upper and/or lower tract RSV infection, otitis mediaor a respiratory condition related thereto, or the administration of acombination of therapies (e.g., a combination of prophylactic ortherapeutic agents).

The term “antibody”, as used herein, is intended to refer toimmunoglobulin molecules comprised of four polypeptide chains, two heavy(H) chains and two light (L) chains inter-connected by disulfide bonds(i.e., “full antibody molecules”), as well as multimers thereof (e.g.IgM) or antigen-binding fragments thereof. Each heavy chain is comprisedof a heavy chain variable region (“HCVR” or “V_(H)”) and a heavy chainconstant region (comprised of domains C_(H)1, C_(H)2 and C_(H)3). Eachlight chain is comprised of a light chain variable region (“LCVR or“V_(L)”) and a light chain constant region (C_(L)). The V_(H) and V_(L)regions can be further subdivided into regions of hypervariability,termed complementarity determining regions (CDR), interspersed withregions that are more conserved, termed framework regions (FR). EachV_(H) and V_(L) is composed of three CDRs and four FRs, arranged fromamino-terminus to carboxy-terminus in the following order: FR1, CDR1,FR2, CDR2, FR3, CDR3, FR4. In certain embodiments of the invention, theFRs of the antibody (or antigen binding fragment thereof) may beidentical to the human germline sequences, or may be naturally orartificially modified. An amino acid consensus sequence may be definedbased on a side-by-side analysis of two or more CDRs.

Substitution of one or more CDR residues or omission of one or more CDRsis also possible. Antibodies have been described in the scientificliterature in which one or two CDRs can be dispensed with for binding.Padlan et al. (1995 FASEB J. 9:133-139) analyzed the contact regionsbetween antibodies and their antigens, based on published crystalstructures, and concluded that only about one fifth to one third of CDRresidues actually contact the antigen. Padlan also found many antibodiesin which one or two CDRs had no amino acids in contact with an antigen(see also, Vajdos et al. 2002 J Mol Biol 320:415-428).

CDR residues not contacting antigen can be identified based on previousstudies (for example residues H60-H65 in CDRH2 are often not required),from regions of Kabat CDRs lying outside Chothia CDRs, by molecularmodeling and/or empirically. If a CDR or residue(s) thereof is omitted,it is usually substituted with an amino acid occupying the correspondingposition in another human antibody sequence or a consensus of suchsequences. Positions for substitution within CDRs and amino acids tosubstitute can also be selected empirically. Empirical substitutions canbe conservative or non-conservative substitutions.

The fully human monoclonal antibodies disclosed herein may comprise oneor more amino acid substitutions, insertions and/or deletions in theframework and/or CDR regions of the heavy and light chain variabledomains as compared to the corresponding germline sequences. Suchmutations can be readily ascertained by comparing the amino acidsequences disclosed herein to germline sequences available from, forexample, public antibody sequence databases. The present inventionincludes antibodies, and antigen-binding fragments thereof, which arederived from any of the amino acid sequences disclosed herein, whereinone or more amino acids within one or more framework and/or CDR regionsare mutated to the corresponding residue(s) of the germline sequencefrom which the antibody was derived, or to the corresponding residue(s)of another human germline sequence, or to a conservative amino acidsubstitution of the corresponding germline residue(s) (such sequencechanges are referred to herein collectively as “germline mutations”). Aperson of ordinary skill in the art, starting with the heavy and lightchain variable region sequences disclosed herein, can easily producenumerous antibodies and antigen-binding fragments which comprise one ormore individual germline mutations or combinations thereof. In certainembodiments, all of the framework and/or CDR residues within the V_(H)and/or V_(L) domains are mutated back to the residues found in theoriginal germline sequence from which the antibody was derived. In otherembodiments, only certain residues are mutated back to the originalgermline sequence, e.g., only the mutated residues found within thefirst 8 amino acids of FR1 or within the last 8 amino acids of FR4, oronly the mutated residues found within CDR1, CDR2 or CDR3. In otherembodiments, one or more of the framework and/or CDR residue(s) aremutated to the corresponding residue(s) of a different germline sequence(i.e., a germline sequence that is different from the germline sequencefrom which the antibody was originally derived). Furthermore, theantibodies of the present invention may contain any combination of twoor more germline mutations within the framework and/or CDR regions,e.g., wherein certain individual residues are mutated to thecorresponding residue of a particular germline sequence while certainother residues that differ from the original germline sequence aremaintained or are mutated to the corresponding residue of a differentgermline sequence. Once obtained, antibodies and antigen-bindingfragments that contain one or more germline mutations can be easilytested for one or more desired property such as, improved bindingspecificity, increased binding affinity, improved or enhancedantagonistic or agonistic biological properties (as the case may be),reduced immunogenicity, etc. Antibodies and antigen-binding fragmentsobtained in this general manner are encompassed within the presentinvention.

The present invention also includes fully monoclonal antibodiescomprising variants of any of the HCVR, LCVR, and/or CDR amino acidsequences disclosed herein having one or more conservativesubstitutions. For example, the present invention includes antibodieshaving HCVR, LCVR, and/or CDR amino acid sequences with, e.g., 10 orfewer, 8 or fewer, 6 or fewer, 4 or fewer, etc. conservative amino acidsubstitutions relative to any of the HCVR, LCVR, and/or CDR amino acidsequences disclosed herein.

The term “human antibody”, as used herein, is intended to includeantibodies having variable and constant regions derived from humangermline immunoglobulin sequences. The human mAbs of the invention mayinclude amino acid residues not encoded by human germline immunoglobulinsequences (e.g., mutations introduced by random or site-specificmutagenesis in vitro or by somatic mutation in vivo), for example in theCDRs and in particular CDR3. However, the term “human antibody”, as usedherein, is not intended to include mAbs in which CDR sequences derivedfrom the germline of another mammalian species (e.g., mouse), have beengrafted onto human FR sequences.

The term “recombinant” generally refers to any protein, polypeptide, orcell expressing a gene of interest that is produced by geneticengineering methods. The term “recombinant” as used with respect to aprotein or polypeptide, means a polypeptide produced by expression of arecombinant polynucleotide. The proteins used in the immunogeniccompositions of the invention may be isolated from a natural source orproduced by genetic engineering methods.

The antibodies of the invention may, in some embodiments, be recombinanthuman antibodies. The term “recombinant human antibody”, as used herein,is intended to include all human antibodies that are prepared,expressed, created or isolated by recombinant means, such as antibodiesexpressed using a recombinant expression vector transfected into a hostcell (described further below), antibodies isolated from a recombinant,combinatorial human antibody library (described further below),antibodies isolated from an animal (e.g., a mouse) that is transgenicfor human immunoglobulin genes (see e.g., Taylor et al. (1992) Nucl.Acids Res. 20:6287-6295) or antibodies prepared, expressed, created orisolated by any other means that involves splicing of humanimmunoglobulin gene sequences to other DNA sequences. Such recombinanthuman antibodies have variable and constant regions derived from humangermline immunoglobulin sequences. In certain embodiments, however, suchrecombinant human antibodies are subjected to in vitro mutagenesis (or,when an animal transgenic for human Ig sequences is used, in vivosomatic mutagenesis) and thus the amino acid sequences of the V_(H) andV_(L) regions of the recombinant antibodies are sequences that, whilederived from and related to human germline V_(H) and V_(L) sequences,may not naturally exist within the human antibody germline repertoire invivo.

The term “specifically binds,” or “binds specifically to”, or the like,means that an antibody or antigen-binding fragment thereof forms acomplex with an antigen that is relatively stable under physiologicconditions. Specific binding can be characterized by an equilibriumdissociation constant of at least about 1×10⁻⁶ M or less (e.g., asmaller K_(D) denotes a tighter binding). Methods for determiningwhether two molecules specifically bind are well known in the art andinclude, for example, equilibrium dialysis, surface plasmon resonance,and the like. As described herein, antibodies have been identified bysurface plasmon resonance, e.g., BIACORE™, which bind specifically toRSV-F. Moreover, multi-specific antibodies that bind to RSV-F proteinand one or more additional antigens or a bi-specific that binds to twodifferent regions of RSV-F are nonetheless considered antibodies that“specifically bind”, as used herein.

The term “high affinity” antibody refers to those mAbs having a bindingaffinity to RSV-F, expressed as K_(D), of at least 10⁻⁹ M; morepreferably 10⁻¹⁰M, more preferably 10⁻¹¹M, more preferably 10⁻¹²M asmeasured by surface plasmon resonance, e.g., BIACORE™ orsolution-affinity ELISA.

By the term “slow off rate”, “Koff” or “kd” is meant an antibody thatdissociates from RSV-F, with a rate constant of 1×10⁻³ s⁻¹ or less,preferably 1×10⁻⁴ s⁻¹ or less, as determined by surface plasmonresonance, e.g., BIACORE™.

The terms “antigen-binding portion” of an antibody, “antigen-bindingfragment” of an antibody, and the like, as used herein, include anynaturally occurring, enzymatically obtainable, synthetic, or geneticallyengineered polypeptide or glycoprotein that specifically binds anantigen to form a complex. The terms “antigen-binding portion” of anantibody, or “antibody fragment”, as used herein, refers to one or morefragments of an antibody that retains the ability to bind to RSV-F.

The specific embodiments, antibody or antibody fragments of theinvention may be conjugated to a therapeutic moiety (“immunoconjugate”),such as an antibiotic, a second anti-RSV-7 antibody, a vaccine, or atoxoid, or any other therapeutic moiety useful for treating a RSVinfection.

An “isolated antibody”, as used herein, is intended to refer to anantibody that is substantially free of other antibodies (Abs) havingdifferent antigenic specificities (e.g., an isolated antibody thatspecifically binds RSV-F, or a fragment thereof, is substantially freeof Abs that specifically bind antigens other than RSV-F.

A “blocking antibody” or a “neutralizing antibody”, as used herein (oran “antibody that neutralizes RSV-F activity”), is intended to refer toan antibody whose binding to RSV-F results in inhibition of at least onebiological activity of RSV-F. For example, an antibody of the inventionmay aid in blocking the fusion of RSV to a host cell, or preventsyncytia formation, or prevent the primary disease caused by RSV.Alternatively, an antibody of the invention may demonstrate the abilityto ameliorate at least one symptom of the RSV infection. This inhibitionof the biological activity of RSV-F can be assessed by measuring one ormore indicators of RSV-F biological activity by one or more of severalstandard in vitro assays (such as a neutralization assay, as describedherein) or in vivo assays known in the art (for example, animal modelsto look at protection from challenge with RSV following administrationof one or more of the antibodies described herein).

The term “surface plasmon resonance”, as used herein, refers to anoptical phenomenon that allows for the analysis of real-timebiomolecular interactions by detection of alterations in proteinconcentrations within a biosensor matrix, for example using the BIACORE™system (Pharmacia Biosensor AB, Uppsala, Sweden and Piscataway, N.J.).

The term “K_(D)”, as used herein, is intended to refer to theequilibrium dissociation constant of a particular antibody-antigeninteraction.

The term “epitope” refers to an antigenic determinant that interactswith a specific antigen binding site in the variable region of anantibody molecule known as a paratope. A single antigen may have morethan one epitope. Thus, different antibodies may bind to different areason an antigen and may have different biological effects. The term“epitope” also refers to a site on an antigen to which B and/or T cellsrespond. It also refers to a region of an antigen that is bound by anantibody. Epitopes may be defined as structural or functional.Functional epitopes are generally a subset of the structural epitopesand have those residues that directly contribute to the affinity of theinteraction. Epitopes may also be conformational, that is, composed ofnon-linear amino acids. In certain embodiments, epitopes may includedeterminants that are chemically active surface groupings of moleculessuch as amino acids, sugar side chains, phosphoryl groups, or sulfonylgroups, and, in certain embodiments, may have specific three-dimensionalstructural characteristics, and/or specific charge characteristics.

The term “substantial identity” or “substantially identical,” whenreferring to a nucleic acid or fragment thereof, indicates that, whenoptimally aligned with appropriate nucleotide insertions or deletionswith another nucleic acid (or its complementary strand), there isnucleotide sequence identity in at least about 90%, and more preferablyat least about 95%, 96%, 97%, 98% or 99% of the nucleotide bases, asmeasured by any well-known algorithm of sequence identity, such asFASTA, BLAST or GAP, as discussed below. A nucleic acid molecule havingsubstantial identity to a reference nucleic acid molecule may, incertain instances, encode a polypeptide having the same or substantiallysimilar amino acid sequence as the polypeptide encoded by the referencenucleic acid molecule.

As applied to polypeptides, the term “substantial similarity” or“substantially similar” means that two peptide sequences, when optimallyaligned, such as by the programs GAP or BESTFIT using default gapweights, share at least 90% sequence identity, even more preferably atleast 95%, 98% or 99% sequence identity. Preferably, residue positions,which are not identical, differ by conservative amino acidsubstitutions. A “conservative amino acid substitution” is one in whichan amino acid residue is substituted by another amino acid residuehaving a side chain (R group) with similar chemical properties (e.g.,charge or hydrophobicity). In general, a conservative amino acidsubstitution will not substantially change the functional properties ofa protein. In cases where two or more amino acid sequences differ fromeach other by conservative substitutions, the percent or degree ofsimilarity may be adjusted upwards to correct for the conservativenature of the substitution. Means for making this adjustment are wellknown to those of skill in the art. See, e.g., Pearson (1994) MethodsMol. Biol. 24: 307-331, which is herein incorporated by reference.Examples of groups of amino acids that have side chains with similarchemical properties include 1) aliphatic side chains: glycine, alanine,valine, leucine and isoleucine; 2) aliphatic-hydroxyl side chains:serine and threonine; 3) amide-containing side chains: asparagine andglutamine; 4) aromatic side chains: phenylalanine, tyrosine, andtryptophan; 5) basic side chains: lysine, arginine, and histidine; 6)acidic side chains: aspartate and glutamate, and 7) sulfur-containingside chains: cysteine and methionine. Preferred conservative amino acidssubstitution groups are: valine-leucine-isoleucine,phenylalanine-tyrosine, lysine-arginine, alanine-valine,glutamate-aspartate, and asparagine-glutamine. Alternatively, aconservative replacement is any change having a positive value in thePAM250 log-likelihood matrix disclosed in Gonnet et al. (1992) Science256: 1443 45, herein incorporated by reference. A “moderatelyconservative” replacement is any change having a nonnegative value inthe PAM250 log-likelihood matrix.

Sequence similarity for polypeptides is typically measured usingsequence analysis software. Protein analysis software matches similarsequences using measures of similarity assigned to varioussubstitutions, deletions and other modifications, including conservativeamino acid substitutions. For instance, GCG software contains programssuch as GAP and BESTFIT which can be used with default parameters todetermine sequence homology or sequence identity between closely relatedpolypeptides, such as homologous polypeptides from different species oforganisms or between a wild type protein and a mutein thereof. See,e.g., GCG Version 6.1. Polypeptide sequences also can be compared usingFASTA with default or recommended parameters; a program in GCG Version6.1. FASTA (e.g., FASTA2 and FASTA3) provides alignments and percentsequence identity of the regions of the best overlap between the queryand search sequences (Pearson (2000) supra). Another preferred algorithmwhen comparing a sequence of the invention to a database containing alarge number of sequences from different organisms is the computerprogram BLAST, especially BLASTP or TBLASTN, using default parameters.See, e.g., Altschul et al. (1990) J. Mol. Biol. 215: 403 410 and (1997)Nucleic Acids Res. 25:3389 402, each of which is herein incorporated byreference.

In specific embodiments, the antibody or antibody fragment for use inthe method of the invention may be mono-specific, bi-specific, ormulti-specific. Multi-specific antibodies may be specific for differentepitopes of one target polypeptide or may contain antigen-bindingdomains specific for epitopes of more than one target polypeptide. Anexemplary bi-specific antibody format that can be used in the context ofthe present invention involves the use of a first immunoglobulin (Ig)C_(H)3 domain and a second Ig C_(H)3 domain, wherein the first andsecond Ig C_(H)3 domains differ from one another by at least one aminoacid, and wherein at least one amino acid difference reduces binding ofthe bi-specific antibody to Protein A as compared to a bi-specificantibody lacking the amino acid difference. In one embodiment, the firstIg C_(H)3 domain binds Protein A and the second Ig C_(H)3 domaincontains a mutation that reduces or abolishes Protein A binding such asan H95R modification (by IMGT exon numbering; H435R by EU numbering).The second C_(H)3 may further comprise an Y96F modification (by IMGT;Y436F by EU). Further modifications that may be found within the secondC_(H)3 include: D16E, L18M, N44S, K52N, V57M, and V82I (by IMGT; D356E,L358M, N384S, K392N, V397M, and V422I by EU) in the case of IgG1 mAbs;N44S, K52N, and V82I (IMGT; N384S, K392N, and V422I by EU) in the caseof IgG2 mAbs; and Q15R, N44S, K52N, V57M, R69K, E79Q, and V82I (by IMGT;Q355R, N384S, K392N, V397M, R409K, E419Q, and V422I by EU) in the caseof IgG4 mAbs. Variations on the bi-specific antibody format describedabove are contemplated within the scope of the present invention.

By the phrase “therapeutically effective amount” is meant an amount thatproduces the desired effect for which it is administered. The exactamount will depend on the purpose of the treatment, and will beascertainable by one skilled in the art using known techniques (see, forexample, Lloyd (1999) The Art, Science and Technology of PharmaceuticalCompounding).

An “immunogenic composition” relates to a composition containing anantigen/immunogen, e.g. a microorganism, such as a virus or a bacterium,or a component thereof, a protein, a polypeptide, a fragment of aprotein or polypeptide, a whole cell inactivated, subunit or attenuatedvirus, or a polysaccharide, or combination thereof, administered tostimulate the recipient's humoral and/or cellular immune systems to oneor more of the antigens/immunogens present in the immunogeniccomposition. The immunogenic compositions of the present invention canbe used to treat a human susceptible to RSV infection, by means ofadministering the immunogenic compositions via a systemic route. Theseadministrations can include injection via the intramuscular (i.m.),intradermal (i.d.), intranasal or inhalation route, or subcutaneous(s.c.) routes; application by a patch or other transdermal deliverydevice. In one embodiment, the immunogenic composition may be used inthe manufacture of a vaccine or in the elicitation of polyclonal ormonoclonal antibodies that could be used to passively protect or treat amammal.

The terms “vaccine” or “vaccine composition”, which are usedinterchangeably, refer to a composition comprising at least oneimmunogenic composition that induces an immune response in an animal.

In one embodiment of the invention, the protein of interest comprises anantigen. The terms “antigen,” “immunogen,” “antigenic,” “immunogenic,”“antigenically active,” and “immunologically active” when made inreference to a molecule, refer to any substance that is capable ofinducing a specific humoral and/or cell-mediated immune response. In oneembodiment, the antigen comprises an epitope, as defined above.

“Immunologically protective amount”, as used herein, is an amount of anantigen effective to induce an immunogenic response in the recipientthat is adequate to prevent or ameliorate signs or symptoms of disease,including adverse health effects or complications thereof. Eitherhumoral immunity or cell-mediated immunity or both can be induced. Theimmunogenic response of an animal to a composition can be evaluated,e.g., indirectly through measurement of antibody titers, lymphocyteproliferation assays, or directly through monitoring signs and symptomsafter challenge with the microorganism. The protective immunityconferred by an immunogenic composition or vaccine can be evaluated bymeasuring, e.g., reduction of shed of challenge organisms, reduction inclinical signs such as mortality, morbidity, temperature, and overallphysical condition, health and performance of the subject. The immuneresponse can comprise, without limitation, induction of cellular and/orhumoral immunity. The amount of a composition or vaccine that istherapeutically effective can vary, depending on the particular organismused, or the condition of the animal being treated or vaccinated.

“Immune response”, or “immunological response” as used herein, in asubject refers to the development of a humoral immune response, acellular-immune response, or a humoral and a cellular immune response toan antigen/immunogen. A “humoral immune response” refers to one that isat least in part mediated by antibodies. A “cellular immune response” isone mediated by T-lymphocytes or other white blood cells or both, andincludes the production of cytokines, chemokines and similar moleculesproduced by activated T-cells, white blood cells, or both. Immuneresponses can be determined using standard immunoassays andneutralization assays, which are known in the art. “Immunogenicity”, asused herein, refers to the capability of a protein or polypeptide toelicit an immune response directed specifically against a bacteria orvirus that causes the identified disease,

General Description

Respiratory syncytial virus (RSV) is a negative sense, single strandedRNA virus that is the leading cause of serious respiratory tractinfections in infants and children, with the primary infection occurringin children from 6 weeks to 2 years of age and uncommonly in the first 4weeks of life during nosocomial epidemics (Hall et al., 1979, New Engl.J. Med. 300:393-396). (Feigen et al, eds., 1987, In: Textbook ofPediatric Infectious Diseases, W B Saunders, Philadelphia at pages1653-1675; New Vaccine Development, Establishing Priorities, Vol. 1,1985, National Academy Press, Washington D.C. at pages 397-409;Ruuskanen et al., 1993, Curr. Probl. Pediatr. 23:50-79; Hall et al.,1979, New Engl. J. Med. 300:393-396). Certain populations of childrenare at risk for developing an RSV infection and these include preterminfants (Hall et al., 1979, New Engl. J. Med. 300:393-396), childrenwith congenital malformations of the airway, children withbronchopulmonary dysplasia (Groothuis et al., 1988, Pediatrics82:199-203), children with congenital heart disease (MacDonald et al.,New Engl. J. Med. 307:397-400), and children with congenital or acquiredimmunodeficiency (Ogra et al., 1988, Pediatr. Infect. Dis. J. 7:246-249;and Pohl et al., 1992, J. Infect. Dis. 165:166-169), and cystic fibrosis(Abman et al., 1988, J. Pediatr. 113:826-830).

RSV can infect the adult population as well. In this population, RSVcauses primarily an upper respiratory tract disease, although elderlypatients may be at greater risk for a serious infection and pneumonia(Evans, A. S., eds., 1989, Viral Infections of Humans. Epidemiology andControl, 3^(rd) ed., Plenum Medical Book, New York at pages 525-544), aswell as adults who are immunosuppressed, particularly bone marrowtransplant patients (Hertz et al., 1989, Medicine 68:269-281). Other atrisk patients include those suffering from congestive heart failure andthose suffering from chronic obstructive pulmonary disease (ie. COPD).There have also been reports of epidemics among nursing home patientsand institutionalized young adults (Falsey, A. R., 1991, Infect. ControlHosp. Epidemiol. 12:602-608; and Garvie et al., 1980, Br. Med. J.281:1253-1254).

While treatment options for established RSV disease are limited, moresevere forms of the disease of the lower respiratory tract often requireconsiderable supportive care, including administration of humidifiedoxygen and respiratory assistance (Fields et al., eds, 1990, FieldsVirology, 2^(nd) ed., Vol. 1, Raven Press, New York at pages 1045-1072).

Ribavirin, which is the only drug approved for treatment of infection,has been shown to be effective in the treatment of pneumonia andbronchiolitis associated with RSV infection, and has been shown tomodify the course of severe RSV disease in immunocompetent children(Smith et al., 1991, New Engl. J. Med. 325:24-29). However, the use ofribavirin is limited due to concerns surrounding its potential risk topregnant women who may be exposed to the aerosolized drug while it isbeing administered in a hospital environment. Its use is also limiteddue to its relatively high cost.

Other peptide inhibitors of RSV infection have been identified, whichinhibit viral growth in vitro, but have failed when tested in vivo, mostlikely due to lack of oral availability and a relatively low half lifein circulation (Lambert, D. M., et al. (1996), PNAS (USA) 93:2186-2191;Magro, M. et al., (2010), J. Virol. 84:7970-7982; Park, M. et al.(2011), Anal. Biochem. 409:195-201).

Other small molecule inhibitors of RSV infection have also beenidentified, but have been discontinued for various reasons, some ofwhich may be due to toxic side effects (Wyde, P. R. et al. (1998),Antiviral Res. 38:31-42; Nikitenko, A. A. et al. (2001), Bioorg Med ChemLett 11:1041-1044; Douglas, J. L., et al. (2003), J. Virol 77:5054-5064;Bonfanti, J. F. et al, (2008), J. Med Chem 51:875-896).

Similarly, while a vaccine may be useful, no commercially availablevaccine has been developed to date. Several vaccine candidates have beenabandoned and others are under development (Murphy et al., 1994, VirusRes. 32:13-36). The development of a vaccine has proven to beproblematic. In particular, immunization would be required in theimmediate neonatal period since the peak incidence of lower respiratorytract disease occurs at 2-5 months of age. However, it is known that theneonatal immune response is immature at that time. Plus, the infant atthat point in time still has high titers of maternally acquired RSVantibody, which might reduce vaccine immunogenicity (Murphy et al.,1988, J. Virol. 62:3907-3910; and Murphy et al., 1991, Vaccine9:185-189).

Currently, passive immunization appears to be the only approved approachto prophylaxis of RSV disease. Initial evidence that suggested aprotective role for IgG was obtained from studies demonstrating maternalantibody in ferrets (Prince, G. A., Ph.D. diss., University ofCalifornia, Los Angeles, 1975) and humans (Lambrecht et al, 1976, J.Infect. Dis. 134:211-217; and Glezen et al., 1981, J. Pediatr.98:708-715).

Hemming et al. (Morell et al., eds., 1986, Clinical Use of IntravenousImmunoglobulins, Academic Press, London at pages 285-294) recognized thepossible utility of RSV antibody in treatment or prevention of RSVinfection during studies involving the pharmacokinetics of anintravenous immune globulin (IVIG) in newborns suspected of havingneonatal sepsis. This same group of investigators then examined theability of hyperimmune serum or immune globulin, enriched for RSVneutralizing antibody, to protect cotton rats and primates against RSVinfection (Prince et al., 1985, Virus Res. 3:193-206; Prince et al.,1990, J. Virol. 64:3091-3092; Hemming et al., 1985, J. Infect. Dis.152:1083-1087; Prince et al., 1983, Infect. lmmun. 42:81-87; and Princeet al., 1985, J. Virol. 55:517-520). Results of these studies suggestedthat RSV neutralizing antibody given prophylactically inhibitedrespiratory tract replication of RSV in cotton rats. When giventherapeutically, RSV antibody reduced pulmonary viral replication bothin cotton rats and in a nonhuman primate model.

More recent studies have concentrated on the role of two glycoproteins,designated F and G, which are found on the surface of RSV, as targets ofneutralizing antibodies, due to the role of these glycoproteins in viralattachment and fusion with the host cell (Fields et al., 1990, supra;and Murphy et al., 1994, supra). The G protein binds to a specificcellular receptor and the F protein promotes fusion of the virus withthe cell. The F protein is also expressed on the surface of infectedcells and is responsible for subsequent fusion with other cells leadingto syncytia formation. Thus, antibodies to the F protein may directlyneutralize virus, or block fusion of the virus with the cell, or preventcell to cell spread by preventing syncytia formation.

The first humanized antibody approved for use in pediatric patients forprevention of serious lower respiratory tract disease caused by RSV waspalivizumab (SYNAGIS®), which immunospecifically binds to the F proteinand is administered intramuscularly at recommended monthly doses of 15mg/kg of body weight throughout the RSV season (November through Aprilin the northern hemisphere). SYNAGIS® is composed of 95% human and 5%murine antibody sequences. See, Johnson et al, 1997, J. Infect. Diseases176:1215-1224 and U.S. Pat. No. 5,824,307, the entire contents of whichare incorporated herein by reference.

While SYNAGIS® has been successfully used for the prevention of RSVinfection in pediatric patients, the need for multiple visits to thedoctor's office for multiple intramuscular doses of 15 mg/kg of SYNAGIS®was not only inconvenient for the patient but could also result inmissed doses. Thus, there was a need for development of antibodies thatretained the immunospecificity for the RSV antigen, but which were morepotent, with an improved pharmacokinetic profile, and thus have anoverall improved therapeutic profile. Such an antibody is described inU.S Patent Publication 2003/0091584 and is known as motavizumab(NUMAX™). Although NUMAX™ has improved binding characteristics that mayovercome the higher dosing requirements described above for SYNAGIS®, italso had a 3 to 5 fold increase in the frequency and severity ofhypersensitivity reactions compared to SYNAGIS®. NUMAX™ was thenwithdrawn from future development.

Accordingly, there is still a need for effective therapies against RSVinfections, and in particular, there is a need to identify a more potentantibody for preventing and treating RSV infections, but without theadverse side effects associated with those described above. Theantibodies described herein, while exhibiting a lower binding affinityfor RSV-F (i.e. the antibodies of the present invention do not bind astightly to RSV-F as palivizumab) than that described for palivizumab ormotavizumab appears to exhibit better neutralization capabilities andaddresses those needs.

In certain embodiments, the antibodies of the invention are obtainedfrom mice immunized with a primary immunogen, such as a whole RSVparticle, either live, attenuated, or inactivated, or with a recombinantform of the virus, or with a purified F protein (See GenBank accessionnumber AAX23994.1 (SEQ ID NO: 354)), or a recombinantly produced Fprotein (See SEQ ID NO: 353), followed by immunization with a secondaryimmunogen (whole virus, or purified F protein), or with animmunogenically active fragment of the F protein.

The immunogen may be DNA encoding the F protein or an active fragmentthereof.

The immunogen may be derived from the N-terminal or C-terminal domain ofeither the 67 KDa precursor (F0), or from either of the two fragmentsgenerated from the precursor by a furin-like protease yielding twodisulfide linked polypeptides, designated as F2 and F1, from the N and Cterminal, respectively. The fragment may be derived from any of theknown regions of RSV-F protein (See Sun, Z. et al. (2013), Viruses5:211-225).

The full-length amino acid sequence of RSV-F is shown as SEQ ID NO: 354and is also shown in GenBank accession number AAX23994.1.

A genetic construct containing the F protein of RSV is shown as SEQ IDNO: 353.

In certain embodiments, antibodies that bind specifically to RSV-F maybe prepared using fragments of the above-noted regions, or peptides thatextend beyond the designated regions by about 5 to about 20 amino acidresidues from either, or both, the N or C terminal ends of the regionsdescribed herein. In certain embodiments, any combination of theabove-noted regions or fragments thereof may be used in the preparationof RSV-F specific antibodies. In certain embodiments, any one or more ofthe above-noted regions of RSV-F, or fragments thereof may be used forpreparing monospecific, bispecific, or multispecific antibodies.

Antigen-Binding Fragments of Antibodies

Unless specifically indicated otherwise, the term “antibody,” as usedherein, shall be understood to encompass antibody molecules comprisingtwo immunoglobulin heavy chains and two immunoglobulin light chains(i.e., “full antibody molecules”) as well as antigen-binding fragmentsthereof. The terms “antigen-binding portion” of an antibody,“antigen-binding fragment” of an antibody, and the like, as used herein,include any naturally occurring, enzymatically obtainable, synthetic, orgenetically engineered polypeptide or glycoprotein that specificallybinds an antigen to form a complex. The terms “antigen-binding portion”of an antibody, or “antibody fragment”, as used herein, refers to one ormore fragments of an antibody that retain the ability to specificallybind to RSV-F. An antibody fragment may include a Fab fragment, aF(ab')2 fragment, a Fv fragment, a dAb fragment, a fragment containing aCDR, or an isolated CDR. Antigen-binding fragments of an antibody may bederived, e.g., from full antibody molecules using any suitable standardtechniques such as proteolytic digestion or recombinant geneticengineering techniques involving the manipulation and expression of DNAencoding antibody variable and (optionally) constant domains. Such DNAis known and/or is readily available from, e.g., commercial sources, DNAlibraries (including, e.g., phage-antibody libraries), or can besynthesized. The DNA may be sequenced and manipulated chemically or byusing molecular biology techniques, for example, to arrange one or morevariable and/or constant domains into a suitable configuration, or tointroduce codons, create cysteine residues, modify, add or delete aminoacids, etc.

Non-limiting examples of antigen-binding fragments include: (i) Fabfragments; (ii) F(ab′)2 fragments; (iii) Fd fragments; (iv) Fvfragments; (v) single-chain Fv (scFv) molecules; (vi) dAb fragments; and(vii) minimal recognition units consisting of the amino acid residuesthat mimic the hypervariable region of an antibody (e.g., an isolatedcomplementarity determining region (CDR) such as a CDR3 peptide), or aconstrained FR3-CDR3-FR4 peptide. Other engineered molecules, such asdomain-specific antibodies, single domain antibodies, domain-deletedantibodies, chimeric antibodies, CDR-grafted antibodies, diabodies,triabodies, tetrabodies, minibodies, nanobodies (e.g. monovalentnanobodies, bivalent nanobodies, etc.), small modularimmunopharmaceuticals (SMIPs), and shark variable IgNAR domains, arealso encompassed within the expression “antigen-binding fragment,” asused herein.

An antigen-binding fragment of an antibody will typically comprise atleast one variable domain. The variable domain may be of any size oramino acid composition and will generally comprise at least one CDR,which is adjacent to or in frame with one or more framework sequences.In antigen-binding fragments having a V_(H) domain associated with aV_(L) domain, the V_(H) and V_(L) domains may be situated relative toone another in any suitable arrangement. For example, the variableregion may be dimeric and contain V_(H)-V_(H), V_(H)-V_(L) orV_(L)-V_(L) dimers. Alternatively, the antigen-binding fragment of anantibody may contain a monomeric V_(H) or V_(L) domain.

In certain embodiments, an antigen-binding fragment of an antibody maycontain at least one variable domain covalently linked to at least oneconstant domain. Non-limiting, exemplary configurations of variable andconstant domains that may be found within an antigen-binding fragment ofan antibody of the present invention include: (i) V_(H)-C_(H)1; (ii)V_(H)-C_(H)2; (iii) V_(H)-C_(H)3; (iv) V_(H)-C_(H)1-C_(H)2; (v)V_(H)-C_(H)1-C_(H)2-C_(H)3; (Vi) V_(H)-C_(H)2-C_(H)3; (vii) V_(H)-C_(L);(viii) V_(L)-C_(H)1; (ix) V_(L)-C_(H)2; (x) V_(L)-C_(H)3; (xi)V_(L)-C_(H)1-C_(H)2; (xii) V_(L)-C_(H)1-C_(H)2-C_(H)3; (xiii)V_(L)-C_(H)2-C_(H)3, and (xiv) V_(L)-C_(L). In any configuration ofvariable and constant domains, including any of the exemplaryconfigurations listed above, the variable and constant domains may beeither directly linked to one another or may be linked by a full orpartial hinge or linker region. A hinge region may consist of at least 2(e.g., 5, 10, 15, 20, 40, 60 or more) amino acids, which result in aflexible or semi-flexible linkage between adjacent variable and/orconstant domains in a single polypeptide molecule. Moreover, anantigen-binding fragment of an antibody of the present invention maycomprise a homo-dimer or hetero-dimer (or other multimer) of any of thevariable and constant domain configurations listed above in non-covalentassociation with one another and/or with one or more monomeric V_(H) orV_(L) domain (e.g., by disulfide bond(s)).

As with full antibody molecules, antigen-binding fragments may bemono-specific or multi-specific (e.g., bi-specific). A multi-specificantigen-binding fragment of an antibody will typically comprise at leasttwo different variable domains, wherein each variable domain is capableof specifically binding to a separate antigen or to a different epitopeon the same antigen. Any multi-specific antibody format, including theexemplary bi-specific antibody formats disclosed herein, may be adaptedfor use in the context of an antigen-binding fragment of an antibody ofthe present invention using routine techniques available in the art.

Preparation of Human Antibodies

Methods for generating human antibodies in transgenic mice are known inthe art. Any such known methods can be used in the context of thepresent invention to make human antibodies that specifically bind toRSV-F.

Using VELOCIMMUNE® technology (see, for example, U.S. Pat. No.6,596,541, Regeneron Pharmaceuticals, VELOCIMMUNE®) or any other knownmethod for generating monoclonal antibodies, high affinity chimericantibodies to RSV-F are initially isolated having a human variableregion and a mouse constant region. The VELOCIMMUNE® technology involvesgeneration of a transgenic mouse having a genome comprising human heavyand light chain variable regions operably linked to endogenous mouseconstant region loci such that the mouse produces an antibody comprisinga human variable region and a mouse constant region in response toantigenic stimulation. The DNA encoding the variable regions of theheavy and light chains of the antibody are isolated and operably linkedto DNA encoding the human heavy and light chain constant regions. TheDNA is then expressed in a cell capable of expressing the fully humanantibody.

Generally, a VELOCIMMUNE® mouse is challenged with the antigen ofinterest, and lymphatic cells (such as B-cells) are recovered from themice that express antibodies. The lymphatic cells may be fused with amyeloma cell line to prepare immortal hybridoma cell lines, and suchhybridoma cell lines are screened and selected to identify hybridomacell lines that produce antibodies specific to the antigen of interest.DNA encoding the variable regions of the heavy chain and light chain maybe isolated and linked to desirable isotypic constant regions of theheavy chain and light chain. Such an antibody protein may be produced ina cell, such as a CHO cell. Alternatively, DNA encoding theantigen-specific chimeric antibodies or the variable domains of thelight and heavy chains may be isolated directly from antigen-specificlymphocytes.

Initially, high affinity chimeric antibodies are isolated having a humanvariable region and a mouse constant region. As in the experimentalsection below, the antibodies are characterized and selected fordesirable characteristics, including affinity, selectivity, epitope,etc. The mouse constant regions are replaced with a desired humanconstant region to generate the fully human antibody of the invention,for example wild-type or modified IgG1 or IgG4. While the constantregion selected may vary according to specific use, high affinityantigen-binding and target specificity characteristics reside in thevariable region.

In certain embodiments, the antibodies of the instant invention possessaffinities (K_(D)) ranging from about 1.0×10 ⁻⁷ M to about 1.0×10⁻¹²M,when measured by binding to antigen either immobilized on solid phase orin solution phase. In certain embodiments, the antibodies of theinvention possess affinities (K_(D)) ranging from about 1×10⁻⁷ M toabout 6×1 0⁻¹⁰M, when measured by binding to antigen either immobilizedon solid phase or in solution phase. In certain embodiments, theantibodies of the invention possess affinities (K_(D)) ranging fromabout 1×10⁻⁷ M to about 9×10⁻¹⁰M, when measured by binding to antigeneither immobilized on solid phase or in solution phase. The mouseconstant regions are replaced with desired human constant regions togenerate the fully human antibodies of the invention. While the constantregion selected may vary according to specific use, high affinityantigen-binding and target specificity characteristics reside in thevariable region. Surprisingly, certain antibodies of the presentinvention, while demonstrating lower affinities than motavizumab, aremore potent in terms of virus neutralization.

Bioequivalents

The anti-RSV-F antibodies and antibody fragments of the presentinvention encompass proteins having amino acid sequences that vary fromthose of the described antibodies, but that retain the ability to bindRSV-F. Such variant antibodies and antibody fragments comprise one ormore additions, deletions, or substitutions of amino acids when comparedto parent sequence, but exhibit biological activity that is essentiallyequivalent to that of the described antibodies. Likewise, theantibody-encoding DNA sequences of the present invention encompasssequences that comprise one or more additions, deletions, orsubstitutions of nucleotides when compared to the disclosed sequence,but that encode an antibody or antibody fragment that is essentiallybioequivalent to an antibody or antibody fragment of the invention.

Two antigen-binding proteins, or antibodies, are consideredbioequivalent if, for example, they are pharmaceutical equivalents orpharmaceutical alternatives whose rate and extent of absorption do notshow a significant difference when administered at the same molar doseunder similar experimental conditions, either single does or multipledose. Some antibodies will be considered equivalents or pharmaceuticalalternatives if they are equivalent in the extent of their absorptionbut not in their rate of absorption and yet may be consideredbioequivalent because such differences in the rate of absorption areintentional and are reflected in the labeling, are not essential to theattainment of effective body drug concentrations on, e.g., chronic use,and are considered medically insignificant for the particular drugproduct studied.

In one embodiment, two antigen-binding proteins are bioequivalent ifthere are no clinically meaningful differences in their safety, purity,and potency.

In one embodiment, two antigen-binding proteins are bioequivalent if apatient can be switched one or more times between the reference productand the biological product without an expected increase in the risk ofadverse effects, including a clinically significant change inimmunogenicity, or diminished effectiveness, as compared to continuedtherapy without such switching.

In one embodiment, two antigen-binding proteins are bioequivalent ifthey both act by a common mechanism or mechanisms of action for thecondition or conditions of use, to the extent that such mechanisms areknown.

Bioequivalence may be demonstrated by in vivo and/or in vitro methods.Bioequivalence measures include, e.g., (a) an in vivo test in humans orother mammals, in which the concentration of the antibody or itsmetabolites is measured in blood, plasma, serum, or other biologicalfluid as a function of time; (b) an in vitro test that has beencorrelated with and is reasonably predictive of human in vivobioavailability data; (c) an in vivo test in humans or other mammals inwhich the appropriate acute pharmacological effect of the antibody (orits target) is measured as a function of time; and (d) in awell-controlled clinical trial that establishes safety, efficacy, orbioavailability or bioequivalence of an antibody.

Bioequivalent variants of the antibodies of the invention may beconstructed by, for example, making various substitutions of residues orsequences or deleting terminal or internal residues or sequences notneeded for biological activity. For example, cysteine residues notessential for biological activity can be deleted or replaced with otheramino acids to prevent formation of unnecessary or incorrectintramolecular disulfide bridges upon renaturation. In other contexts,bioequivalent antibodies may include antibody variants comprising aminoacid changes, which modify the glycosylation characteristics of theantibodies, e.g., mutations that eliminate or remove glycosylation.

Biological Characteristics of the Antibodies

In general, the antibodies of the present invention may function bybinding to RSV-F and in so doing act to block the fusion of the viralmembrane with the host cell membrane. The antibodies of the presentinvention may also function by binding to RSV-F and in so doing blockthe cell to cell spread of the virus and block syncytia formationassociated with RSV infection of cells.

In certain embodiments, the antibodies of the present invention mayfunction by blocking or inhibiting RSV fusion to the cell membrane bybinding to any other region or fragment of the full length native Fprotein, the amino acid sequence of which is shown in SEQ ID NO: 354,also shown as GenBank accession number AAX23994.1. The antibodies mayalso bind to any region which is found in SEQ ID NO: 353, or to afragment found within SEQ ID NO: 353.

In one embodiment, the invention provides a fully human monoclonalantibody or antigen-binding fragment thereof that binds to the F proteinof RSV subtype A or B, wherein the antibody or fragment thereof exhibitsone or more of the following characteristics: (a) is a fully humanmonoclonal antibody; (b) exhibits a K_(D) ranging from about 1×10⁻⁷ M toabout 6×10⁻¹⁰M; (c) is capable of neutralizing respiratory syncytialvirus subtype A and subtype B strains in vitro; (d) demonstrates theability to significantly reduce the viral load in an animal model of RSVinfection (e) demonstrates a 1-2 logs greater reduction of nasal and/orlung viral titers when compared to palivizumab; (f) demonstrates aneffective dose 99 (ED₉₉) of about 0.15 mg/kg or less when administeredsubcutaneously in a mouse model of RSV subtype A infection, or an ED₉₉of about 0.62 mg/kg or less when administered in a cotton rat model ofRSV subtype A infection, or an ED₉₉ of about 2.5 mg/kg or less whenadministered in a cotton rat model of RSV subtype B infection; (g)demonstrates an ED₉₉ that is about 2 to 3 fold lower than the ED₉₉ forpalivizumab or motavizumab; (h) demonstrates a neutralization potencyagainst one or more subtype A laboratory strains of RSV that is about 15to 17 fold improvement over palivizumab, or demonstrates aneutralization potency against one or more subtype A clinical strains ofRSV that is about 10 to 22 fold improvement over palivizumab; (i)demonstrates a neutralization potency against a subtype B laboratorystrain of RSV that is about a 2 to 5 fold improvement over palivizumab(j) demonstrates a neutralization potency against a subtype A laboratorystrain or clinical strain of RSV that is about a 0.5 to 2 foldimprovement over AM-22; (k) demonstrates a neutralization potencyagainst one or more subtype B laboratory strains of RSV that is about a2.5 to 17 fold improvement over AM-22; (l) comprises a HCVR having anamino acid sequence selected from the group consisting of SEQ ID NO: 2,18, 34, 50, 66, 82, 98, 114, 130, 146, 162, 178, 194, 210, 226, 242,258, 274, 290, 306, 322 and 338, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity; (m) comprises a LCVR having an amino acid sequenceselected from the group consisting of SEQ ID NO: 10, 26, 42, 58, 74, 90,106, 122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298, 314,330 and 346, or a substantially similar sequence thereof having at least90%, at least 95%, at least 98% or at least 99% sequence identity; (n)comprises a HCDR3 domain having an amino acid sequence selected from thegroup consisting of SEQ ID NO: 8, 24, 40, 56, 72, 88, 104, 120, 136,152, 168, 184, 200, 216, 232, 248, 264, 280, 296, 312, 328, and 344, ora substantially similar sequence thereof having at least 90%, at least95%, at least 98% or at least 99% sequence identity and a LCDR3 domainhaving an amino acid sequence selected from the group consisting of SEQID NO: 16, 32, 48, 64, 80, 96, 112, 128, 144, 160, 176, 192, 208, 224,240, 256, 272, 288, 304, 320, 336 and 352, or a substantially similarsequence thereof having at least 90%, at least 95%, at least 98% or atleast 99% sequence identity; (o) comprises a HCDR1 domain having anamino acid sequence selected from the group consisting of SEQ ID NO: 4,20, 36, 52, 68, 84, 100, 116, 132, 148, 164, 180, 196, 212, 228, 244,260, 276, 292, 308, 324 and 340, or a substantially similar sequencethereof having at least 90%, at least 95%, at least 98% or at least 99%sequence identity; a HCDR2 domain having an amino acid sequence selectedfrom the group consisting of SEQ ID NO: 6, 22, 38, 54, 70, 86, 102, 118,134, 150, 166, 182, 198, 214, 230, 246, 262, 278, 294, 310, 326 and 342,or a substantially similar sequence thereof having at least 90%, atleast 95%, at least 98% or at least 99% sequence identity; a LCDR1domain having an amino acid sequence selected from the group consistingof SEQ ID NO: 12, 28, 44, 60, 76, 92, 108, 124, 140, 156, 172, 188, 204,220, 236, 252, 268, 284, 300, 316, 332 and 348, or a substantiallysimilar sequence thereof having at least 90%, at least 95%, at least 98%or at least 99% sequence identity; and a LCDR2 domain having an aminoacid sequence selected from the group consisting of SEQ ID NO: 14, 30,46, 62, 78, 94, 110, 126, 142, 158, 174, 190, 206, 222, 238, 254, 270,286, 302, 318, 334 and 350, or a substantially similar sequence thereofhaving at least 90%, at least 95%, at least 98% or at least 99% sequenceidentity; (p) interacts with an amino acid sequence comprising residuesranging from about position 161 to about position 188 of SEQ ID NO: 354;(q) interacts with either the serine at position 173 of SEQ ID NO: 354,or the threonine at position 174 of SEQ ID NO: 354, or both the serineat position 173 of SEQ ID NO: 354 and the threonine at position 174 ofSEQ ID NO: 354; (r) does not cross-compete for binding to RSV-F proteinwith palivizumab or motavizumab; (s) inhibits fusion of the virus to thecell.

Certain anti-RSV-F antibodies of the present invention are able to bindto the F protein of RSV and neutralize the infectivity of both subtypesA and B of RSV as determined by in vitro assays. The ability of theantibodies of the invention to bind to and neutralize the infectivity ofthe subtypes of RSV may be measured using any standard method known tothose skilled in the art, including binding assays, or neutralizationassays, or in vivo protection assays, as described herein.

Non-limiting, exemplary in vitro and in vivo assays for measuringbinding activity and in vitro neutralization and in vivo efficacy areillustrated in Examples 3, 4, 5, 7, 8, 9, 10, 11 and 12 herein. InExample 3, the binding affinities and kinetic constants of humananti-RSV-F antibodies were determined by surface plasmon resonance andthe measurements were conducted on a Biacore 4000 or T200 instrument. InExample 4, the potency of the antibodies was tested in a RSVmicro-neutralization assay. Example 5 demonstrates the ability of theantibodies of the invention to neutralize an RSV infection in vivo intwo different animal models. Examples 7 and 8 demonstrate theinteraction of the antibodies of the invention with particular bindingsites on RSV-F protein. Examples 9 and 10 demonstrate the neutralizationcapabilities of the antibodies with several laboratory and clinicalstrains of RSV subtypes A and B. Example 11 demonstrates the ability ofthe antibodies of the invention to inhibit fusion of the virus to cells.Example 12 demonstrates the cross-competition of various antibodies forbinding to RSV-F.

Epitope Mapping and Related Technologies

Various techniques known to persons of ordinary skill in the art can beused to determine whether an antibody “interacts with one or more aminoacids” within a polypeptide or protein. Exemplary techniques include,for example, a routine cross-blocking assay such as that describedAntibodies, Harlow and Lane (Cold Spring Harbor Press, Cold SpringHarb., N.Y.) can be performed. Other methods include alanine scanningmutational analysis, peptide blot analysis (Reineke (2004) Methods MolBiol 248:443-63), peptide cleavage analysis crystallographic studies andNMR analysis. In addition, methods such as epitope excision, epitopeextraction and chemical modification of antigens can be employed (Tomer(2000) Protein Science 9: 487-496). Another method that can be used toidentify the amino acids within a polypeptide with which an antibodyinteracts is hydrogen/deuterium exchange detected by mass spectrometry.In general terms, the hydrogen/deuterium exchange method involvesdeuterium-labeling the protein of interest, followed by binding theantibody to the deuterium-labeled protein. Next, the protein/antibodycomplex is transferred to water and exchangeable protons within aminoacids that are protected by the antibody complex undergodeuterium-to-hydrogen back-exchange at a slower rate than exchangeableprotons within amino acids that are not part of the interface. As aresult, amino acids that form part of the protein/antibody interface mayretain deuterium and therefore exhibit relatively higher mass comparedto amino acids not included in the interface. After dissociation of theantibody, the target protein is subjected to protease cleavage and massspectrometry analysis, thereby revealing the deuterium-labeled residuesthat correspond to the specific amino acids with which the antibodyinteracts. See, e.g., Ehring (1999) Analytical Biochemistry267(2):252-259; Engen and Smith (2001) Anal. Chem. 73:256A-265A.

The term “epitope” refers to a site on an antigen to which B and/or Tcells respond. B-cell epitopes can be formed both from contiguous aminoacids or noncontiguous amino acids juxtaposed by tertiary folding of aprotein. Epitopes formed from contiguous amino acids are typicallyretained on exposure to denaturing solvents, whereas epitopes formed bytertiary folding are typically lost on treatment with denaturingsolvents. An epitope typically includes at least 3, and more usually, atleast 5 or 8-10 amino acids in a unique spatial conformation.

Modification-Assisted Profiling (MAP), also known as AntigenStructure-based Antibody Profiling (ASAP) is a method that categorizeslarge numbers of monoclonal antibodies (mAbs) directed against the sameantigen according to the similarities of the binding profile of eachantibody to chemically or enzymatically modified antigen surfaces (US2004/0101920, herein specifically incorporated by reference in itsentirety). Each category may reflect a unique epitope either distinctlydifferent from or partially overlapping with epitope represented byanother category. This technology allows rapid filtering of geneticallyidentical antibodies, such that characterization can be focused ongenetically distinct antibodies. When applied to hybridoma screening,MAP may facilitate identification of rare hybridoma clones that producemAbs having the desired characteristics. MAP may be used to sort theantibodies of the invention into groups of antibodies binding differentepitopes.

In certain embodiments, the antibodies or antigen-binding fragments ofthe invention interact with an amino acid sequence comprising amino acidresidues ranging from about position 161 to about position 188 of SEQ IDNO: 354. In certain embodiments, the antibodies of the invention mayinteract with amino acid residues that extend beyond the regionidentified above by about 5 to 10 amino acid residues, or by about 10 to15 amino acid residues, or by about 15 to 20 amino acid residues towardseither the amino terminal or the carboxy terminal of the RSV-F protein.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid sequence selected from the groupconsisting of SEQ ID NO: 355 and 356.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid residue within residues 161through 188 of SEQ ID NO: 354.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with at least one amino acid residue within SEQ ID NO: 355 orSEQ ID NO:356.

In one embodiment, the invention provides an isolated human monoclonalantibody that specifically binds RSV-F, or an antigen-binding fragmentthereof, wherein the antibody or antigen-binding fragment thereofinteracts with either the serine at position 173 of SEQ ID NO: 354, orthe threonine at position 174 of SEQ ID NO: 354, or both the serine atposition 173 of SEQ ID NO: 354 and the threonine at position 174 of SEQID NO: 354.

The present invention includes anti-RSV-F antibodies that bind to thesame epitope as any of the specific exemplary antibodies describedherein in Table 1. Likewise, the present invention also includesanti-RSV-F antibodies that compete for binding to RSV-F fragment withany of the specific exemplary antibodies described herein in Table 1.

In certain embodiments, the antibodies of the present invention do notcross-compete for binding to RSV-F with palivizumab, motavizumab, orAM-22.

In certain embodiments, the antibodies of the present invention do notbind to the same epitope on RSV-F protein as palivizumab or motavizumab.

In certain embodiments, the antibodies of the present invention do notbind to an epitope on RSV-F ranging from amino acid residue 255 to aminoacid residue 276 of SEQ ID NO: 354.

One can easily determine whether an antibody binds to the same epitopeas, or competes for binding with, a reference anti-RSV-F antibody byusing routine methods known in the art. For example, to determine if atest antibody binds to the same epitope as a reference RSV-F antibody ofthe invention, the reference antibody is allowed to bind to a RSV-Fprotein or peptide under saturating conditions. Next, the ability of atest antibody to bind to the RSV-F molecule is assessed. If the testantibody is able to bind to RSV-F following saturation binding with thereference anti-RSV-F antibody, it can be concluded that the testantibody binds to a different epitope than the reference anti-RSV-Fantibody. On the other hand, if the test antibody is not able to bind tothe RSV-F molecule following saturation binding with the referenceanti-RSV-F antibody, then the test antibody may bind to the same epitopeas the epitope bound by the reference anti-RSV-F antibody of theinvention.

To determine if an antibody competes for binding with a referenceanti-RSV-F antibody, the above-described binding methodology isperformed in two orientations: In a first orientation, the referenceantibody is allowed to bind to a RSV-F molecule under saturatingconditions followed by assessment of binding of the test antibody to theRSV-F molecule. In a second orientation, the test antibody is allowed tobind to a RSV-F molecule under saturating conditions followed byassessment of binding of the reference antibody to the RSV-F molecule.If, in both orientations, only the first (saturating) antibody iscapable of binding to the RSV-F molecule, then it is concluded that thetest antibody and the reference antibody compete for binding to RSV-F.As will be appreciated by a person of ordinary skill in the art, anantibody that competes for binding with a reference antibody may notnecessarily bind to the identical epitope as the reference antibody, butmay sterically block binding of the reference antibody by binding anoverlapping or adjacent epitope.

Two antibodies bind to the same or overlapping epitope if eachcompetitively inhibits (blocks) binding of the other to the antigen.That is, a 1-, 5-, 10-, 20- or 100-fold excess of one antibody inhibitsbinding of the other by at least 50% but preferably 75%, 90% or even 99%as measured in a competitive binding assay (see, e.g., Junghans et al.,Cancer Res. 1990 50:1495-1502). Alternatively, two antibodies have thesame epitope if essentially all amino acid mutations in the antigen thatreduce or eliminate binding of one antibody reduce or eliminate bindingof the other. Two antibodies have overlapping epitopes if some aminoacid mutations that reduce or eliminate binding of one antibody reduceor eliminate binding of the other.

Additional routine experimentation (e.g., peptide mutation and bindinganalyses) can then be carried out to confirm whether the observed lackof binding of the test antibody is in fact due to binding to the sameepitope as the reference antibody or if steric blocking (or anotherphenomenon) is responsible for the lack of observed binding. Experimentsof this sort can be performed using ELISA, RIA, surface plasmonresonance, flow cytometry or any other quantitative or qualitativeantibody-binding assay available in the art.

Immunoconjugates

The invention encompasses a human RSV-F monoclonal antibody conjugatedto a therapeutic moiety (“immunoconjugate”), such as an agent that iscapable of reducing the severity of primary infection with RSV, or toameliorate at least one symptom associated with RSV infection, includingcoughing, fever, pneumonia, or the severity thereof. Such an agent maybe a second different antibody to RSV-F, or a vaccine. The type oftherapeutic moiety that may be conjugated to the anti-RSV-F antibody andwill take into account the condition to be treated and the desiredtherapeutic effect to be achieved. Alternatively, if the desiredtherapeutic effect is to treat the sequelae or symptoms associated withRSV infection, or any other condition resulting from such infection,such as, but not limited to, pneumonia, it may be advantageous toconjugate an agent appropriate to treat the sequelae or symptoms of thecondition, or to alleviate any side effects of the antibodies of theinvention. Examples of suitable agents for forming immunoconjugates areknown in the art, see for example, WO 05/103081.

Multi-Specific Antibodies

The antibodies of the present invention may be mono-specific,bi-specific, or multi-specific. Multi-specific antibodies may bespecific for different epitopes of one target polypeptide or may containantigen-binding domains specific for more than one target polypeptide.See, e.g., Tutt et al., 1991, J. lmmunol. 147:60-69; Kufer et al, 2004,Trends Biotechnol. 22:238-244. The antibodies of the present inventioncan be linked to or co-expressed with another functional molecule, e.g.,another peptide or protein. For example, an antibody or fragment thereofcan be functionally linked (e.g., by chemical coupling, genetic fusion,noncovalent association or otherwise) to one or more other molecularentities, such as another antibody or antibody fragment to produce abi-specific or a multi-specific antibody with a second bindingspecificity.

An exemplary bi-specific antibody format that can be used in the contextof the present invention involves the use of a first immunoglobulin (Ig)C_(H3) domain and a second Ig C_(H3) domain, wherein the first andsecond Ig C_(H3) domains differ from one another by at least one aminoacid, and wherein at least one amino acid difference reduces binding ofthe bi-specific antibody to Protein A as compared to a bi-specificantibody lacking the amino acid difference. In one embodiment, the firstIg C_(H3) domain binds Protein A and the second Ig C_(H3) domaincontains a mutation that reduces or abolishes Protein A binding such asan H95R modification (by IMGT exon numbering; H435R by EU numbering).The second C_(H3) may further comprise a Y96F modification (by IMGT;Y436F by EU). Further modifications that may be found within the secondC_(H3) include: D16E, L18M, N44S, K52N, V57M, and V82I (by IMGT; D356E,L358M, N384S, K392N, V397M, and V422I by EU) in the case of IgG1antibodies; N44S, K52N, and V82I (IMGT; N384S, K392N, and V422I by EU)in the case of IgG2 antibodies; and Q15R, N44S, K52N, V57M, R69K, E79Q,and V82I (by IMGT; Q355R, N384S, K392N, V397M, R409K, E419Q, and V422Iby EU) in the case of IgG4 antibodies. Variations on the bi-specificantibody format described above are contemplated within the scope of thepresent invention.

Therapeutic Administration and Formulations

The invention provides therapeutic compositions comprising theanti-RSV-F antibodies or antigen-binding fragments thereof of thepresent invention. The administration of therapeutic compositions inaccordance with the invention will be administered with suitablecarriers, excipients, and other agents that are incorporated intoformulations to provide improved transfer, delivery, tolerance, and thelike. A multitude of appropriate formulations can be found in theformulary known to all pharmaceutical chemists: Remington'sPharmaceutical Sciences, Mack Publishing Company, Easton, Pa. Theseformulations include, for example, powders, pastes, ointments, jellies,waxes, oils, lipids, lipid (cationic or anionic) containing vesicles(such as LIPOFECTIN™), DNA conjugates, anhydrous absorption pastes,oil-in-water and water-in-oil emulsions, emulsions carbowax(polyethylene glycols of various molecular weights), semi-solid gels,and semi-solid mixtures containing carbowax. See also Powell et al.“Compendium of excipients for parenteral formulations” PDA (1998) JPharm Sci Technol 52:238-311.

The dose of each of the antibodies of the invention may vary dependingupon the age and the size of a subject to be administered, targetdisease, conditions, route of administration, and the like. When theantibodies of the present invention are used for treating a RSVinfection in a patient, or for treating one or more symptoms associatedwith a RSV infection, such as the cough or pneumonia associated with aRSV infection in a patient, or for lessening the severity of thedisease, it is advantageous to administer each of the antibodies of thepresent invention intravenously or subcutaneously normally at a singledose of about 0.01 to about 30 mg/kg body weight, more preferably about0.1 to about 20 mg/kg body weight, or about 0.1 to about 15 mg/kg bodyweight, or about 0.02 to about 7 mg/kg body weight, about 0.03 to about5 mg/kg body weight, or about 0.05 to about 3 mg/kg body weight, orabout 1 mg/kg body weight, or about 3.0 mg/kg body weight, or about 10mg/kg body weight, or about 20 mg/kg body weight. Multiple doses may beadministered as necessary. Depending on the severity of the condition,the frequency and the duration of the treatment can be adjusted. Incertain embodiments, the antibodies or antigen-binding fragments thereofof the invention can be administered as an initial dose of at leastabout 0.1 mg to about 800 mg, about 1 to about 600 mg, about 5 to about300 mg, or about 10 to about 150 mg, to about 100 mg, or to about 50 mg.In certain embodiments, the initial dose may be followed byadministration of a second or a plurality of subsequent doses of theantibodies or antigen-binding fragments thereof in an amount that can beapproximately the same or less than that of the initial dose, whereinthe subsequent doses are separated by at least 1 day to 3 days; at leastone week, at least 2 weeks; at least 3 weeks; at least 4 weeks; at least5 weeks; at least 6 weeks; at least 7 weeks; at least 8 weeks; at least9 weeks; at least 10 weeks; at least 12 weeks; or at least 14 weeks.

Various delivery systems are known and can be used to administer thepharmaceutical composition of the invention, e.g., encapsulation inliposomes, microparticles, microcapsules, recombinant cells capable ofexpressing the mutant viruses, receptor mediated endocytosis (see, e.g.,Wu et al. (1987) J. Biol. Chem. 262:4429-4432). Methods of introductioninclude, but are not limited to, intradermal, transdermal,intramuscular, intraperitoneal, intravenous, subcutaneous, intranasal,epidural and oral routes. The composition may be administered by anyconvenient route, for example by infusion or bolus injection, byabsorption through epithelial or mucocutaneous linings (e.g., oralmucosa, nasal mucosa, rectal and intestinal mucosa, etc.) and may beadministered together with other biologically active agents.Administration can be systemic or local. It may be delivered as anaerosolized formulation (See US2011/0311515 and US2012/0128669). Thedelivery of agents useful for treating respiratory diseases byinhalation is becoming more widely accepted (See A. J. Bitonti and J. A.Dumont, (2006), Adv. Drug Deliv. Rev, 58:1106-1118). In addition tobeing effective at treating local pulmonary disease, such a deliverymechanism may also be useful for systemic delivery of antibodies (SeeMaillet et al. (2008), Pharmaceutical Research, Vol. 25, No. 6, 2008).

The pharmaceutical composition can be also delivered in a vesicle, inparticular a liposome (see, for example, Langer (1990) Science249:1527-1533).

In certain situations, the pharmaceutical composition can be deliveredin a controlled release system. In one embodiment, a pump may be used.In another embodiment, polymeric materials can be used. In yet anotherembodiment, a controlled release system can be placed in proximity ofthe composition's target, thus requiring only a fraction of the systemicdose.

The injectable preparations may include dosage forms for intravenous,subcutaneous, intracutaneous and intramuscular injections, dripinfusions, etc. These injectable preparations may be prepared by methodspublicly known. For example, the injectable preparations may beprepared, e.g., by dissolving, suspending or emulsifying the antibody orits salt described above in a sterile aqueous medium or an oily mediumconventionally used for injections. As the aqueous medium forinjections, there are, for example, physiological saline, an isotonicsolution containing glucose and other auxiliary agents, etc., which maybe used in combination with an appropriate solubilizing agent such as analcohol (e.g., ethanol), a polyalcohol (e.g., propylene glycol,polyethylene glycol), a nonionic surfactant [e.g., polysorbate 80,HCO-50 (polyoxyethylene (50 mol) adduct of hydrogenated castor oil)],etc. As the oily medium, there are employed, e.g., sesame oil, soybeanoil, etc., which may be used in combination with a solubilizing agentsuch as benzyl benzoate, benzyl alcohol, etc. The injection thusprepared is preferably filled in an appropriate ampoule.

A pharmaceutical composition of the present invention can be deliveredsubcutaneously or intravenously with a standard needle and syringe. Inaddition, with respect to subcutaneous delivery, a pen delivery devicereadily has applications in delivering a pharmaceutical composition ofthe present invention. Such a pen delivery device can be reusable ordisposable. A reusable pen delivery device generally utilizes areplaceable cartridge that contains a pharmaceutical composition. Onceall of the pharmaceutical composition within the cartridge has beenadministered and the cartridge is empty, the empty cartridge can readilybe discarded and replaced with a new cartridge that contains thepharmaceutical composition. The pen delivery device can then be reused.In a disposable pen delivery device, there is no replaceable cartridge.Rather, the disposable pen delivery device comes prefilled with thepharmaceutical composition held in a reservoir within the device. Oncethe reservoir is emptied of the pharmaceutical composition, the entiredevice is discarded.

Numerous reusable pen and autoinjector delivery devices haveapplications in the subcutaneous delivery of a pharmaceuticalcomposition of the present invention. Examples include, but certainlyare not limited to AUTOPEN™ (Owen Mumford, Inc., Woodstock, UK),DISETRONIC™ pen (Disetronic Medical Systems, Burghdorf, Switzerland),HUMALOG MIX 75/25™ pen, HUMALOG™ pen, HUMALIN 70/30™ pen (Eli Lilly andCo., Indianapolis, Ind.), NOVOPEN™ I, II and III (Novo Nordisk,Copenhagen, Denmark), NOVOPEN JUNIOR™ (Novo Nordisk, Copenhagen,Denmark), BD™ pen (Becton Dickinson, Franklin Lakes, N.J.), OPTIPEN™,OPTIPEN PRO™, OPTIPEN STARLET™, and OPTICLIK™ (sanofi-aventis,Frankfurt, Germany), to name only a few. Examples of disposable pendelivery devices having applications in subcutaneous delivery of apharmaceutical composition of the present invention include, butcertainly are not limited to the SOLOSTAR™ pen (sanofi-aventis), theFLEXPEN™ (Novo Nordisk), and the KW IKPEN™ (Eli Lilly), the SURECLICK™Autoinjector (Amgen, Thousands Oaks, Calif.), the PENLET™ (Haselmeier,Stuttgart, Germany), the EPIPEN (Dey, L. P.) and the HUMIRA™ Pen (AbbottLabs, Abbott Park, Ill,), to name only a few.

Advantageously, the pharmaceutical compositions for oral or parenteraluse described above are prepared into dosage forms in a unit dose suitedto fit a dose of the active ingredients. Such dosage forms in a unitdose include, for example, tablets, pills, capsules, injections(ampoules), suppositories, etc. The amount of the aforesaid antibodycontained is generally about 5 to about 500 mg per dosage form in a unitdose; especially in the form of injection, it is preferred that theaforesaid antibody is contained in about 5 to about 100 mg and in about10 to about 250 mg for the other dosage forms.

Administration Regimens

According to certain embodiments of the present invention, multipledoses of an antibody to RSV-F may be administered to a subject over adefined time course. The methods according to this aspect of theinvention comprise sequentially administering to a subject multipledoses of an antibody to RSV-F. As used herein, “sequentiallyadministering” means that each dose of antibody to RSV-F is administeredto the subject at a different point in time, e.g., on different daysseparated by a predetermined interval (e.g., hours, days, weeks ormonths). The present invention includes methods which comprisesequentially administering to the patient a single initial dose of anantibody to RSV-F, followed by one or more secondary doses of theantibody to RSV-F and optionally followed by one or more tertiary dosesof the antibody to RSV-F.

The terms “initial dose,” “secondary doses,” and “tertiary doses,” referto the temporal sequence of administration of the antibody to RSV-F.Thus, the “initial dose” is the dose which is administered at thebeginning of the treatment regimen (also referred to as the “baselinedose”); the “secondary doses” are the doses which are administered afterthe initial dose; and the “tertiary doses” are the doses which areadministered after the secondary doses. The initial, secondary, andtertiary doses may all contain the same amount of antibody to RSV-F, butgenerally may differ from one another in terms of frequency ofadministration. In certain embodiments, however, the amount of antibodyto RSV-F contained in the initial, secondary and/or tertiary doses varyfrom one another (e.g., adjusted up or down as appropriate) during thecourse of treatment. In certain embodiments, two or more (e.g., 2, 3, 4,or 5) doses are administered at the beginning of the treatment regimenas “loading doses” followed by subsequent doses that are administered ona less frequent basis (e.g., “maintenance doses”).

In one exemplary embodiment of the present invention, each secondaryand/or tertiary dose is administered 1 to 26 (e.g., 1, 1½, 2, 2½, 3,3½,4, 4½, 5, 5½, 6, 6½, 7, 7½, 8, 8½, 9, 9½, 10, 10½, 11, 11½, 12, 12½,13, 13½, 14, 14½, 15, 15½, 16, 16½, 17, 17½, 18, 18½, 19, 19½, 20, 20½,21, 21½,22, 22½,23, 23½, 24, 24½, 25, 25½, 26, 26½, or more) weeks afterthe immediately preceding dose. The phrase “the immediately precedingdose,” as used herein, means, in a sequence of multiple administrations,the dose of antibody to RSV-F which is administered to a patient priorto the administration of the very next dose in the sequence with nointervening doses.

The methods according to this aspect of the invention may compriseadministering to a patient any number of secondary and/or tertiary dosesof an antibody to RSV-F. For example, in certain embodiments, only asingle secondary dose is administered to the patient. In otherembodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) secondarydoses are administered to the patient. Likewise, in certain embodiments,only a single tertiary dose is administered to the patient. In otherembodiments, two or more (e.g., 2, 3, 4, 5, 6, 7, 8, or more) tertiarydoses are administered to the patient.

In embodiments involving multiple secondary doses, each secondary dosemay be administered at the same frequency as the other secondary doses.For example, each secondary dose may be administered to the patient 1 to2 weeks after the immediately preceding dose. Similarly, in embodimentsinvolving multiple tertiary doses, each tertiary dose may beadministered at the same frequency as the other tertiary doses. Forexample, each tertiary dose may be administered to the patient 2 to 4weeks after the immediately preceding dose. Alternatively, the frequencyat which the secondary and/or tertiary doses are administered to apatient can vary over the course of the treatment regimen. The frequencyof administration may also be adjusted during the course of treatment bya physician depending on the needs of the individual patient followingclinical examination.

Therapeutic Uses of the Antibodies

Due to their binding to/interaction with, the RSV fusion protein(RSV-F), the present antibodies are useful for preventing fusion of thevirus with the host cell membrane, for preventing cell to cell virusspread, and for inhibition of syncytia formation. As such, theantibodies of the present invention are useful for preventing aninfection of a subject with RSV when administered prophylactically.Alternatively, the antibodies of the present invention may be useful forameliorating at least one symptom associated with the infection, such ascoughing, fever, pneumonia, or for lessening the severity, duration,and/or frequency of the infection. The antibodies of the invention arealso contemplated for prophylactic use in patients at risk fordeveloping or acquiring an RSV infection. These patients includepre-term infants, full term infants born during RSV season (late fall toearly spring), the elderly (for example, in anyone 65 years of age orolder), or patients immunocompromised due to illness or treatment withimmunosuppressive therapeutics, or patients who may have an underlyingmedical condition that predisposes them to an RSV infection (forexample, cystic fibrosis patients, patients with congestive heartfailure or other cardiac conditions, patients with airway impairment,patients with COPD). It is contemplated that the antibodies of theinvention may be used alone, or in conjunction with a second agent, orthird agent for treating RSV infection, or for alleviating at least onesymptom or complication associated with the RSV infection, such as thefever, coughing, bronchiolitis, or pneumonia associated with, orresulting from such an infection. The second or third agents may bedelivered concurrently with the antibodies of the invention, or they maybe administered separately, either before or after the antibodies of theinvention. The second or third agent may be an anti-viral such asribavirin, an NSAID or other agents to reduce fever or pain, anothersecond but different antibody that specifically binds RSV-F, an agent(e.g. an antibody) that binds to another RSV antigen, such as RSV-G, avaccine against RSV, an siRNA specific for an RSV antigen.

In yet a further embodiment of the invention the present antibodies areused for the preparation of a pharmaceutical composition for treatingpatients suffering from a RSV infection. In yet another embodiment ofthe invention the present antibodies are used for the preparation of apharmaceutical composition for reducing the severity of a primaryinfection with RSV, or for reducing the duration of the infection, orfor reducing at least one symptom associated with the RSV infection. Ina further embodiment of the invention the present antibodies are used asadjunct therapy with any other agent useful for treating an RSVinfection, including an antiviral, a toxoid, a vaccine, a second RSV-Fantibody, or any other antibody specific for an RSV antigen, includingan RSV-G antibody, or any other palliative therapy known to thoseskilled in the art.

Combination Therapies

As noted above, the methods of the present invention, according tocertain embodiments, comprise administering to the subject one or moreadditional therapeutic agents in combination with an antibody to RSV-F.As used herein, the expression “in combination with” means that theadditional therapeutic agents are administered before, after, orconcurrent with the pharmaceutical composition comprising the anti-RSV-Fantibody. The term “in combination with” also includes sequential orconcomitant administration of the anti-RSV-F antibody and a secondtherapeutic agent.

For example, when administered “before” the pharmaceutical compositioncomprising the anti-RSV-F antibody, the additional therapeutic agent maybe administered about 72 hours, about 60 hours, about 48 hours, about 36hours, about 24 hours, about 12 hours, about 10 hours, about 8 hours,about 6 hours, about 4 hours, about 2 hours, about 1 hour, about 30minutes, about 15 minutes or about 10 minutes prior to theadministration of the pharmaceutical composition comprising theanti-RSV-F antibody. When administered “after” the pharmaceuticalcomposition comprising the anti-RSV-F antibody, the additionaltherapeutic agent may be administered about 10 minutes, about 15minutes, about 30 minutes, about 1 hour, about 2 hours, about 4 hours,about 6 hours, about 8 hours, about 10 hours, about 12 hours, about 24hours, about 36 hours, about 48 hours, about 60 hours or about 72 hoursafter the administration of the pharmaceutical composition comprisingthe anti-RSV-F antibodies. Administration “concurrent” or with thepharmaceutical composition comprising the anti-RSV-F antibody means thatthe additional therapeutic agent is administered to the subject in aseparate dosage form within less than 5 minutes (before, after, or atthe same time) of administration of the pharmaceutical compositioncomprising the anti-RSV-F antibody, or administered to the subject as asingle combined dosage formulation comprising both the additionaltherapeutic agent and the anti-RSV-F antibody.

Combination therapies may include an anti-RSV-F antibody of theinvention and any additional therapeutic agent that may beadvantageously combined with an antibody of the invention, or with abiologically active fragment of an antibody of the invention.

For example, a second or third therapeutic agent may be employed to aidin reducing the viral load in the lungs, such as an antiviral, forexample, ribavirin. The antibodies may also be used in conjunction withother therapies, as noted above, including a toxoid, a vaccine specificfor RSV, a second antibody specific for RSV-F, or an antibody specificfor another RSV antigen, such as RSV-G.

Diagnostic Uses of the Antibodies

The anti-RSV antibodies of the present invention may also be used todetect and/or measure RSV in a sample, e.g., for diagnostic purposes. Itis envisioned that confirmation of an infection thought to be caused byRSV may be made by measuring the presence of the virus through use ofany one or more of the antibodies of the invention. Exemplary diagnosticassays for RSV may comprise, e.g., contacting a sample, obtained from apatient, with an anti-RSV-F antibody of the invention, wherein theanti-RSV-F antibody is labeled with a detectable label or reportermolecule or used as a capture ligand to selectively isolate the viruscontaining the F protein from patient samples. Alternatively, anunlabeled anti-RSV-F antibody can be used in diagnostic applications incombination with a secondary antibody which is itself detectablylabeled. The detectable label or reporter molecule can be aradioisotope, such as ³H, ¹⁴C, ³²P, ³⁵S, or ¹²⁵I; a fluorescent orchemiluminescent moiety such as fluorescein isothiocyanate, orrhodamine; or an enzyme such as alkaline phosphatase, β-galactosidase,horseradish peroxidase, or luciferase. Specific exemplary assays thatcan be used to detect or measure RSV containing the F protein in asample include enzyme-linked immunosorbent assay (ELISA),radioimmunoassay (RIA), and fluorescence-activated cell sorting (FACS).

Samples that can be used in RSV diagnostic assays according to thepresent invention include any tissue or fluid sample obtainable from apatient, which contains detectable quantities of RSV-F protein, orfragments thereof, under normal or pathological conditions. Generally,levels of RSV-F in a particular sample obtained from a healthy patient(e.g., a patient not afflicted with a disease or condition associatedwith the presence of RSV-F) will be measured to initially establish abaseline, or standard, level of the F protein from RSV. This baselinelevel of RSV-F can then be compared against the levels of RSV-F measuredin samples obtained from individuals suspected of having an RSVinfection, or symptoms associated with such infection.

Vaccines and Immunogenic Compositions

One aspect of the invention provides an immunogenic composition, or avaccine, that when administered to an individual, preferably a human,induces an immune response in such individual to a Respiratory SyncytialVirus (RSV) antigen, for example, a RSV-F polypeptide, wherein thecomposition may comprise a recombinant RSV-F protein, or a polypeptidefragment of a RSV-F protein, or an epitope contained within and obtainedfrom an antigen of the RSV-F polypeptide or a fragment thereof, and/orcomprises DNA and/or RNA which encodes and expresses an epitope from anantigen of the RSV-F polypeptide, or other polypeptides of theinvention. The immunogenic composition or vaccine may be usedtherapeutically or prophylactically and may be used to elicit antibodyimmunity and/or cellular immunity, such as cellular immunity arisingfrom CTL or CD4+ T cells.

In one embodiment of the invention, the immunogenic composition, orvaccine, may comprise the RSV-F protein as shown in SEQ ID NO: 354. Inone embodiment of the invention, the immunogenic composition, orvaccine, may comprise a RSV-F polypeptide fragment comprising residues161 through 188 of SEQ ID NO: 354. In one embodiment of the invention,the immunogenic composition, or vaccine, may comprise one or more aminoacid residues contained within SEQ ID NO: 355 and/or SEQ ID NO: 356. Inone embodiment of the invention, the immunogenic composition, orvaccine, may comprise SEQ ID NO: 355 and/or SEQ ID NO: 356.

In a related aspect, the invention provides a method for inducing animmune response in an individual, particularly a mammal, preferablyhumans, by administering to an individual an immunogenic composition, ora vaccine, comprising a RSV-F protein, or an immunogenic fragmentthereof, or a RSV-F antigen or an immunogenic fragment thereofcomprising one or more epitopes contained within the RSV-F antigen orfragment thereof, adequate to produce an antibody and/or a T cell immuneresponse to protect the individual from infection, particularlyinfection with Respiratory Syncytial Virus (RSV). Also provided aremethods of using the immunogenic compositions, or vaccines of theinvention for inducing an immune response that results in inhibiting, orslowing the progression of cell to cell viral spread. Methods are alsoprovided for ameliorating at least one symptom associated with RSVinfection by administering an immunogenic composition, or a vaccine,comprising at least one RSV-F antigen, or one or more epitopes containedwithin the RSV-F antigen, which when administered will induce an immuneresponse in the individual.

For example, in one embodiment the invention provides a method ofinducing an immune response in an individual comprising delivering tothe individual an immunogenic composition, or vaccine comprising, anRSV-F antigen (e.g. the amino acid sequence shown in SEQ ID NO: 354), oran antigenic fragment thereof, (e.g. a polypeptide comprising residues161 through 188 of SEQ ID NO: 354), or a nucleic acid vector comprisinga nucleotide sequence to direct expression of such viral polypeptide, ora fragment or a variant thereof, in vivo in order to induce an immuneresponse.

In one embodiment of the invention, the polypeptide to be used in animmunogenic composition or in a vaccine for inducing an immune responsein an individual comprises residues 161 through 188 of SEQ ID NO: 354.In one embodiment of the invention, the polypeptide to be used in animmunogenic composition or in a vaccine for inducing an immune responsein an individual comprises one or more amino acid residues containedwithin SEQ ID NO: 355 and/or SEQ ID NO: 356. In one embodiment of theinvention, the polypeptide to be used in an immunogenic composition orin a vaccine for inducing an immune response in an individual comprisesSEQ ID NO: 355 and/or SEQ ID NO: 356. In one embodiment of theinvention, the immunogenic composition, or vaccine, may elicit anantibody response specific for the RSV-F antigen of RSV, wherein theantibodies generated interact with either the serine at position 173 ofSEQ ID NO: 354, or the threonine at position 354, or both the serine atposition 173 of SEQ ID NO: 354 and the threonine at position 174 of SEQID NO: 354.

In certain embodiments, it is advantageous for the RSV-F antigens orfragments thereof to be formulated into immunogenic compositions, orvaccines that comprise immunogenic, preferably immunologicallyeffective, amounts of additional antigens to elicit immunity to otherpathogens, preferably viruses and/or bacteria. Such additional antigensmay include an influenza virus antigen, an antigen from metapneumovirusor from a coronavirus, an antigen from Haemophilus influenzae,Streptococcus pneumonia, or Bordetella pertussis. Other RSV antigens maybe included in the immunogenic compositions, or vaccines, such as theRSV-G glycoprotein, or immunogenic fragments thereof, the HN protein, orderivatives thereof. In certain embodiments, influenza virus antigens tobe included in the immunogenic compositions or vaccines of the inventionmay include whole, live or inactivated virus, split influenza virus,grown in eggs or MDCK cells, or Vero cells or whole flu virosomes, orpurified or recombinant proteins thereof, such as HA, NP, NA, or Mproteins, or combinations thereof.

In certain embodiments of the invention, the immunogenic composition, orvaccine formulation may comprise an immunogenic recombinant polypeptideand/or polynucleotide of the invention, or a combination thereof,together with a suitable carrier/excipient, such as a pharmaceuticallyacceptable carrier/excipient. The immunogenic composition and/or vaccineis preferably administered parenterally, including, for example,administration that is subcutaneous, intramuscular, intravenous, orintradermal. Formulations suitable for parenteral administration includeaqueous and non-aqueous sterile injection solutions which may containanti-oxidants, buffers, bacteriostatic compounds and solutes whichrender the formulation isotonic with the bodily fluid, preferably theblood, of the individual; and aqueous and non-aqueous sterilesuspensions which may include suspending agents or thickening agents.The formulations may be presented in unit-dose or multi-dose containers,for example, sealed ampoules and vials and may be stored in afreeze-dried condition requiring only the addition of the sterile liquidcarrier immediately prior to use.

The immunogenic composition, or vaccine formulation of the invention mayalso include adjuvants for enhancing the immunogenicity of theformulation. At this time, the only adjuvant widely used in humans hasbeen alum (aluminum phosphate or aluminum hydroxide) and calciumphosphate gels. Freund's complete adjuvant and other adjuvants used inresearch and veterinary applications have toxicities, which limit theirpotential use in human vaccines. However, chemically definedpreparations such as oil emulsions and surfactant based formulations,e.g., MF59 (microfluidized detergent stabilized oil-in-water emulsion),QS21 (purified saponin), AS02 [SBAS2] (oil-in-water emulsion+MPL+QS-21), Montanide ISA-51 and ISA-720 (stabilized water-in-oilemulsion), are also in development. Furthermore, microbial derivatives(natural and synthetic), e.g., muramyl dipeptide, monophosphoryl lipid A(e.g. 3 De-O-acylated monophosphoryl lipid A, also known as 3D-MPL,which is manufactured by Ribi lmmunochem, Montana), Detox (MPL+M.Phleicell wall skeleton), AGP [RC-529] (synthetic acylatedmonosaccharide), DCChol (lipoidal immunostimulators able to selforganize into liposomes), OM-174 (lipid A derivative), CpG motifs(synthetic oligonucleotides containing immunostimulatory CpG motifs),modified LT and CT (genetically modified bacterial toxins to providenon-toxic adjuvant effects), and QS21, an Hplc purified non-toxicfraction derived from the bark of Quillaja Saponaria Molina, have allbeen in development for human use.

A preferred form of 3 De-O-acylated monophosphoryl lipid A is disclosedin European Patent 0 689 454 B1 (SmithKline Beecham Biologicals SA).

Other particulate adjuvants include, e.g., virosomes (unilamellarliposomal vehicles incorporating a viral antigen), AS04 ([SBAS4] Al saltwith MPL), ISCOMS (structured complex of saponins and lipids),polylactide co-glycolide (PLG).

Other suitable adjuvants include all acceptable immunostimulatorycompounds, such as cytokines, chemokines, or colony stimulating factors.For example, these may include the interleukins IL-1, IL-2, IL-4, IL-7,IL-12, gamma-interferon, and hGM-CSF.

It is to be understood that the adjuvant and/or immunostimulatorycompound to be used will depend on the subject to which the vaccine orimmunogenic composition will be administered, the route of injection andthe number of injections to be given.

While the invention has been described with reference to certain RSV-Fpolypeptides, it is to be understood that this covers fragments of thenaturally occurring polypeptides, and similar polypeptides withadditions, deletions or substitutions which do not substantially affectthe immunogenic properties of the recombinant polypeptides orpolynucleotides.

EXAMPLES

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how tomake and use the methods and compositions of the invention, and are notintended to limit the scope of what the inventors regard as theirinvention. Efforts have been made to ensure accuracy with respect tonumbers used (e.g., amounts, temperature, etc.) but some experimentalerrors and deviations should be accounted for. Unless indicatedotherwise, parts are parts by weight, molecular weight is averagemolecular weight, temperature is in degrees Centigrade, and pressure isat or near atmospheric.

Example 1 Generation of Human Antibodies to RSV-F Protein

An immunogen comprising any one of the following can be used to generateantibodies to RSV-F protein. In certain embodiments, the antibodies ofthe invention are obtained from mice immunized with a primary immunogen,such as a whole respiratory syncytial virus isolate, either live,attenuated or killed/inactivated. The mice may be given one or morebooster shots containing either the same virus isolate, or they may beboosted with the RSV-F protein itself. In certain embodiments, the miceare injected with live virus, followed by boosting with the constructshown as SEQ ID NO: 353, or with isolated RSV-F protein, obtained from avirus isolate or prepared recombinantly. (See also GenBank accessionnumber AAX23994.1)

In certain embodiments, the antibodies of the invention are obtainedfrom mice immunized with a primary immunogen, such as a biologicallyactive RSV, subtype A or B, and/or the RSV fusion (F) protein, or animmunogenic fragment of the RSV fusion (RSV-F) protein, or DNA encodingthe full length protein or the active fragment thereof. The immunogenmay be delivered to the animal via any route including but not limitedto intramuscularly, subcutaneously, intravenously or intranasally.

In certain embodiments, whole virus, or the RSV-F protein or fragmentsthereof may be used for preparing monospecific, bispecific, ormultispecific antibodies.

The whole virus, or full length proteins, or fragments thereof, thatwere used as immunogens, as noted above, were administered directly,with an adjuvant to stimulate the immune response, to a VELOCIMMUNE®mouse comprising DNA encoding human Immunoglobulin heavy and kappa lightchain variable regions. The antibody immune response was monitored by aRSV-F immunoassay. When a desired immune response was achieved,splenocytes were harvested and fused with mouse myeloma cells topreserve their viability and form hybridoma cell lines. The hybridomacell lines were screened and selected to identify cell lines thatproduce RSV-F-specific antibodies. Using this technique, and the variousimmunogens described above, several chimeric antibodies (i.e.,antibodies possessing human variable domains and mouse constant domains)were obtained; certain exemplary antibodies generated in this mannerwere designated as H1M3621N, H1M3622N, H1M2634N and H1M3627N.

Anti-RSV-F antibodies were also isolated directly from antigen-positiveB cells without fusion to myeloma cells, as described in U.S.2007/0280945A1, herein specifically incorporated by reference in itsentirety. Using this method, several fully human anti-RSV-F antibodies(i.e., antibodies possessing human variable domains and human constantdomains) were obtained; exemplary antibodies generated in this mannerwere designated as follows: H1H3564P, H1H3565P, H1H3566P, H1H3567P,H1H3581P, H1H3583P, H1H3589P, H1H3591P, H1H3592P, H1H3597P, H1H3598P,H1H3603P, H1H3604P, H1H3605P, H1H3607P, H1H3608P2, H1H3592P2 andH1H3592P3.

The biological properties of the exemplary antibodies generated inaccordance with the methods of this Example are described in detail inthe Examples set forth below.

Example 2 Heavy and Light Chain Variable Region Amino Acid Sequences

Table 1 sets forth the heavy and light chain variable region amino acidsequence pairs of selected antibodies specific for RSV-F protein andtheir corresponding antibody identifiers. Antibodies are typicallyreferred to herein according to the following nomenclature: Fc prefix(e.g. “H4H”, “H1M, “H2M”), followed by a numerical identifier (e.g.“3117” as shown in Table 1), followed by a “P” or “N” suffix. Thus,according to this nomenclature, an antibody may be referred to as, e.g.“H1H3117”. The H4H, H1M, and H2M prefixes on the antibody designationsused herein indicate the particular Fc region of the antibody. Forexample, an “H2M” antibody has a mouse IgG2 Fe, whereas an “H4H”antibody has a human IgG4 Fc. As will be appreciated by a person ofordinary skill in the art, an H1M or H2M antibody can be converted to anH4H antibody, and vice versa, but in any event, the variable domains(including the CDRs), which are indicated by the numerical identifiersshown in Table 1, will remain the same. Antibodies having the samenumerical antibody designation, but differing by a letter suffix of N, Bor P refer to antibodies having heavy and light chains with identicalCDR sequences but with sequence variations in regions that fall outsideof the CDR sequences (i.e., in the framework regions). Thus, N, B and Pvariants of a particular antibody have identical CDR sequences withintheir heavy and light chain variable regions but differ from one anotherwithin their framework regions.

Antibody Comparators

Anti-RSV-F antibody controls were included in the following Examples forcomparative purposes. Isotype matched negative controls were also usedin the Examples. One anti-RSV-F control antibody is designated herein asControl I and is a humanized anti-RSV-F antibody with heavy and lightchain variable domain sequences of the palivizumab (SYNAGIS®) humanizedantibody as set forth in U.S. Pat. No. 7,635,568 and U.S. Pat. No.5,824,307. The variable light and heavy chains were expressed with humankappa and gamma-1 constants, respectively. One anti-RSV-F antibody isdesignated herein as Control II and is a humanized anti-RSV-F antibodyvariant of palivizumab, with heavy and light chain variable domainsequences of the motavizumab (NUMAX™) humanized antibody described inUS2003/0091584 and by Wu et al, (2007), J. Mol. Biol. 368:652-665. Thevariable light and heavy chains were expressed with human kappa andgamma-1 constants, respectively. Another anti-RSV-F antibody isdesignated as Control III (also referred to as AM-22) and is describedin U.S. Pat. No. 8,568,726. The amino acid sequence of the heavy andlight chain of AM-22 is shown in SEQ ID NO: 357 (for the heavy chain ofthe antibody) and SEQ ID NO: 358 (for the light chain of the antibody).

TABLE 1 Antibody SEQ ID NOs: Designation HCVR HCDR1 HCDR2 HCDR3 LCVRLCDR1 LCDR2 LCDR3 H1H3564P 2 4 6 8 10 12 14 16 H1H3565P 18 20 22 24 2628 30 32 H1H3566P 34 36 38 40 42 44 46 48 H1H3567P 50 52 54 56 58 60 6264 H1H3581P 66 68 70 72 74 76 78 80 H1H3583P 82 84 86 88 90 92 94 96H1H3589P 98 100 102 104 106 108 110 112 H1H3591P 114 116 118 120 122 124126 128 H1H3592P 130 132 134 136 138 140 142 144 H1H3597P 146 148 150152 154 156 158 160 H1H3598P 162 164 166 168 170 172 174 176 H1H3603P178 180 182 184 186 188 190 192 H1H3604P 194 196 198 200 202 204 206 208H1H3605P 210 212 214 216 218 220 222 224 H1H3607P 226 228 230 232 234236 238 240 H1H3608P2 242 244 246 248 250 252 254 256 H1H3592P2 258 260262 264 266 268 270 272 H1H3592P3 274 276 278 280 282 284 286 288H1M3621N 290 292 294 296 298 300 302 304 H1M3622N 306 308 310 312 314316 318 320 H1M2634N 322 324 326 328 330 332 334 336 H1M3627N 338 340342 344 346 348 350 352

Example 3 Antibody Binding Affinities and Kinetic Constants of HumanMonoclonal Anti-RSV-F Antibodies as Determined by Surface PlasmonResonance

Binding affinities and kinetic constants of human monoclonal anti-RSV-Fantibodies were determined by surface plasmon resonance at 25° C.(Tables 2-3). Measurements were conducted on a Biacore 4000 or T-200instrument. Antibodies, expressed with either mouse Fc (AbPID prefix H1M; H2M) or human IgG1 Fc (AbPID prefix H1H), were captured onto ananti-mouse or anti-human Fc sensor surface (Mab capture format), andsoluble monomeric (RSV-F.mmh; SEQ ID NO: 353) protein was injected overthe surface. All Biacore binding studies were performed in HBST runningbuffer (0.01 M HEPES pH 7.4, 0.15 M NaCl, 3 mM EDTA, 0.005% v/vsurfactant P20). Different concentrations of RSV-F.mmh prepared in HBSTrunning buffer were injected over the anti-RSV-F monoclonal antibodycaptured surface at a flow rate of 30 μl/min (Biacore 4000) or at a flowrate of 50 μl/min (Biacore T-200) and the association of RSV-F.mmh tocaptured monoclonal antibody was monitored for 6 min or 3 minrespectively. The dissociation of RSV-F.mmh from the monoclonal antibodyin HBST running buffer was monitored for 8-10min at 25° C. Kineticassociation (k_(a)) and dissociation (k_(d)) rate constants weredetermined by processing and fitting the data to a 1:1 binding modelusing Scrubber 2.0 curve fitting software. Binding dissociationequilibrium constants (K_(D)) and dissociative half-lives (t½) werecalculated from the kinetic rate constants as: K_(D) (M)=k_(d)/k_(a);and t_(1/2) (min)=(In2/(60*k_(d)).

Anti-RSV-F antibodies of the invention displayed a broad range ofaffinities for RSV-F.mmh. Control I, produced based on the publicsequence of palivizumab set forth in U.S. Pat. No. 7,635,568, andControl II, produced on the public sequence of motavizumab as describedin Wu et al, (2007), (J. Mol. Biol. 368:652-665) displayed theapproximately ˜70-fold difference (control 1; 38 nM vs control II; 0.43nM) in affinity that has been previously reported.

TABLE 2 Biacore Binding Affinities of Hybridoma mAbs at 25° C. Bindingat 25° C./Mab Capture Format AbPID k_(a) (1/Ms) k_(d) (1/s) K_(D) (M) t½(min) H1M3621N 2.05E+05 2.08E−04 1.01E−09 56 H1M3622N 3.84E+04 9.13E−052.38E−09 127 H1M3624N 1.79E+05 1.83E−04 1.02E−09 63 H1M3627N 2.59E+055.23E−04 2.02E−09 22

TABLE 3 Biacore binding affinities of human Fc mAbs at 25° C. Binding at25° C./Mab Capture Format AbPID k_(a) (1/Ms) k_(d) (1/s) K_(D) (M) t½(min) H1H3564P 3.10E+03 7.78E−05 2.50E−08 148 H1H3565P 1.93E+04 5.80E−053.01E−09 199 H1H3566P 2.04E+04 4.20E−05 2.06E−09 275 H1H3567P 6.05E+042.63E−03 4.34E−08 4 H1H3581P NB NB NB NB H1H3583P 8.94E+04 3.08E−033.44E−08 4 H1H3589P 3.77E+04 9.14E−03 2.43E−07 1 H1H3591P 4.46E+041.53E−03 3.42E−08 8 H1H3592P 1.06E+05 4.66E−04 4.39E−09 25 H1H3592P29.93E+04 1.46E−03 1.47E−08 8 H1H3592P3 8.86E+04 7.47E−04 8.43E−09 15H1H3597P NB NB NB NB H1H3598P NB NB NB NB H1H3603P 3.00E+03 1.23E−044.10E−08 94 H1H3604P 3.10E+03 9.27E−05 3.00E−08 125 H1H3605P 2.80E+031.68E−04 5.90E−08 69 H1H3607P 4.20E+03 1.48E−04 3.50E−08 78 H1H3608P24.85E+03 2.60E−05 5.35E−09 445 H1H3627N 2.56E+05 1.49E−04 5.81E−10 78Control I 6.75E+04 2.57E−03 3.81E−08 4 Control II 1.89E+05 8.13E−054.29E−10 142 NB: No binding observed under the conditions of theexperiment

Example 4 Respiratory Syncytial Virus Fusion (RSV-F) Protein AntibodiesDisplay Potent Neutralization Capabilities Across RSV Subtype A andSubtype B Strains

Purified antibodies were tested in a RSV micro-neutralization assay todetermine potency. Briefly, 10⁴ HEp-2 cells cultured in MEM high glucosemedium, supplemented with 5% Hyclone FBS, L-glutamine and antibiotics,were seeded into 96-well clear bottom-black microplates and incubatedfor 16-18 hours (37° C., 5% CO₂). Next, various concentrations ofantibodies, starting at 666 nM with subsequent 1:5 dilutions in media,were incubated with the RSV 1540 (A2) strain at an MOI of 0.04 for 2hours (37C, 5% CO₂). Virus-free and irrelevant isotype controls wereincluded.

Post incubation, the antibody:virus mixture was added to the HEp-2 cellsand infection was maintained for 3 days. The degree of infection wasdetermined by fixing cells in 2% PFA and performing an ELISA with Goatanti-RSV/anti-Goat HRP antibodies. Luminescence reagents were added tothe wells and signal was detected using a plate reader (Victor X3,Perkin Elmer). Luminescence values were analyzed by a three-parameterlogistic equation over an 11-point response curve (GraphPad Prism).

The antibodies of the invention displayed a broad range ofneutralization activities against the RSV A2 (1540) strain (Table 4-5).Several antibodies displayed lower IC₅₀ values then control I while onlya few exemplary antibodies H1H3627N, H1H3591P, H1H3592P and H1H3592P3showed better neutralization then control II. Select antibodies(H1H3627N, H1H3592P3) were also tested for their ability toneutralization RSV subtype B strains (Table 6).

This example demonstrates the efficacy of the antibodies of thisinvention to neutralize several strains of RSV-F, across two subtypes,in vitro, with greater potency than previously demonstrated forestablished controls.

TABLE 4 Neutralization potency for selected mAbs against RSV A2 (1540)IC₅₀ [pM] for RSV A2 Neutralization: Trial Trial Trial Trial Trial TrialTrial AbPID 1 2 3 4 5 6 7 H1M3621N 582 180 — — — — — H1M3622N 320  82 —— — — — H1M3624N 540 270 92 — — — — H1M3627N 4  4  5 — — 10  —H1H3564P >10000 — — — — — — H1H3565P >10000 — — — — — — H1H3566P >10000— — — — — — H1H3567P — — — 257  — 390  — H1H3581P >10000 — — — — — —H1H3583P — — — —  50 — — H1H3589P — — — — 300 — — H1H3591P — — — 6 — 8 6H1H3592P — — — 6 — 5 4 H1H3592P3 10  H1H3597P >10000 — — — — — —H1H3598P >10000 — — — — — — H1H3603P >10000 — — — — — — H1H3604P >10000— — — — — — H1H3605P >10000 — — — — — — H1H3607P >10000 — — — — — —H1H3608P2 >10000 — — — — — — H1H3570P >10000 — — — — — — H1H3627N — — —— — — 3 Control 1 1820 950 290  530  160 500  250  Control 2 50  30 2320   12 12  12 

TABLE 5 Neutralization potency for selected mAbs against RSV subtype ASubtype A Neutralization: IC₅₀ & Fold Improvement Relative to Control 1RSV-A2 (1540) RSV-Long Neutral. IC50 Neutral. IC50 AbPID [pM] Fold [pM]Fold H1H3627N 2.6 138  7.3 73 H1H3592P3 10 36 15 35 Control I 360 — 536— Control II 14 25 65 8.2

TABLE 6 Neutralization potency for selected mAbs against RSV subtype BSubtype B Neutralization: IC₅₀ & Fold Improvement Relative to Control 1RSV - 1580 RSV-9320 Neutral. IC50 Neutral. IC50 AbPID [pM] Fold [pM]Fold H1H3627N 6.7 55 11 42 H1H3592P3 31 12 100 4.6 Control I 375 — 460 —Control II 43 8.7 56 8.2

Example 5 Selected Anti-RSV-F Antibodies Display Potent Neutralizationof RSV Infection In Vivo

A. Mouse Model

The exemplary antibodies H1H3627N and H1H3592P3 were selected for invivo RSV neutralization studies using Balb/c mice. Briefly, 7 week oldBalb/c mice (n=4-5) were injected SC at two doses (0.15 or 0.05 mg/kg)using either H1H3627N, H1H3592P3, control I, control II orisotype-matched antibody. The use of carrier antibody (1 mg/kg) wasutilized in all experiments to minimize the loss of anti-RSV-F antibody.

One day post-injection, mice were challenged intranasally with 50 ul(10⁶ pfu) of RSV A2 (1540) strain. Four days post-infection, sera wasdrawn, mice were sacrificed, and lungs were extracted and homogenized in1 mL of PBS using an OmniGLH homogenizer. Lung homogenates werecentrifuged to remove cellular debris and a portion of supernatant wasused to determine anti-RSV-F mAb concentration in the lung. Theremaining supernatant was used to make serial dilutions which wereincubated with HEp-2 cells for 2 hours, to allow viral entry.Subsequently, supernatant was removed and the cells were overlaid with1% methylcellulose. Six days later, cells were stained with crystalviolet and plaques were counted and the log₁₀ viral reduction wascalculated relative to isotype control.

Exemplary antibodies H1H3627N and H1H3592P3 were more efficacious inreducing the viral load in vivo than control I or control II anti-RSV-Fantibodies (Tables 7a-7e). Specifically, at the 0.15 mg/kg dose,antibodies H1H3627N, H1H3592P3 and control II all effectively reducedRSV infection in the lung to near undetectable levels compared tocontrol I (viral reduction log(10) fold change ≥2.10). Total human IgGmeasurements in the lungs and serum confirmed that antibody levels wererelatively consistent between groups.

At a lower administrated dose, greater differentiation in neutralizationefficacy between the three antibodies compared to control I was evident.At 0.05 mg/kg, H1H3592P3 showed the greatest reduction in viral load,with fold changes ranging from 1.49 to >2.07 logs, compared with viralload reduction fold changes of 1.08 to 1.36 logs for H1H3627N and 0.01to 0.65 logs for control II. Control I at this lower dose was onlymoderately effective with viral load reduction changes of 0.03 to 1.03logs.

The results indicate that both H1H3627N and H1H3592P3 are potent RSVneutralizing antibodies in vivo, with the latter showing a trend ofbeing a more effective neutralizer of RSV infection at lower doses.

A dosing range experiment was performed following the same protocoldescribed above, injecting SC 4 different doses of control I antibody(0.6, 0.3, 0.15 and 0.05 mg/kg), and two doses (0.15 and 0.05 mg/kg) ofH1H3592P3 and control II. Viral reduction in the lungs was calculated asa percentage of isotype control (Exp M4, Tables 7d-e).

Exemplary antibody H1H3592P3 was more efficacious in reducing the viralload in vivo (in mouse) than control I or control II anti-RSV-Fantibodies. In addition, the dose of control I required to reach a 99%viral reduction in the lungs was 3-4 fold higher than the dose ofH1H3592P3.

Tables 7(a-e): RSV viral reduction (log (10)) in mice afteradministration of Anti-RSV-F antibodies

TABLE 7a Exp M1 Dose: 0.15 mg/kg Dose: 0.05 mg/kg Mice Viral mAb mAbViral mAb mAb per Reduction [ng/ml] [ng/ml] Reduction [ng/ml] [ng/ml]PID group (log10) Lungs Serum (log10) Lungs Serum H1H3627N 5 >2.10 35 ±18 1041 ± 212 1.20 7 ± 4 274 ± 38 H1H3592P3 5 >2.10 44 ± 14 1731 ±770 >2.07 17 ± 4  438 ± 51 Control I 5 1.02 33 ± 11  895 ± 132 1.03 9 ±5  365 ± 111 Control II 5 >2.10 82 ± 24 1948 ± 429 0.65 7 ± 4 555 ± 80Isotype Ctrl 5 NA 76 ± 28 2180 ± 197 NA 25 ± 2  1287 ± 120

TABLE 7b Exp M2 Dose: 0.15 mg/kg Dose: 0.05 mg/kg Mice Viral mAb mAbViral mAb mAb per Reduction [ng/ml] [ng/ml] Reduction [ng/ml] [ng/ml]PID group (log10) Lungs Serum (log10) Lungs Serum H1H3627N 5 >2.51 23 ±8  724 ± 148 1.08 3 ± 3 300 ± 35 H1H3592P3 5 >2.51 27 ± 5 1261 ± 74 1.49 10 ± 2  333 ± 55 Control I 5 0.79  9 ± 2 611 ± 61 0.15 1 ± 1 221 ±35 Control II 5 2.31 13 ± 8 587 ± 36 0.01 1 ± 3 237 ± 22 Isotype Ctrl 5NA  46 ± 12 1389 ± 170 NA 15 ± 4  498 ± 92

TABLE 7c Exp M3 Dose: 0.15 mg/kg Dose: 0.05 mg/kg Mice Viral mAb mAbViral mAb mAb per Reduction [ng/ml] [ng/ml] Reduction [ng/ml] [ng/ml]PID group (log10) Lungs Serum (log10) Lungs Serum H1H3627N 4 2.7 26 ± 61143 ± 83  1.36 7 ± 1 394 ± 16 H1H3592P3 4 >2.83  31 ± 12  947 ± 1051.66 13 ± 4  371 ± 21 Control I 4 1.00  58 ± 14 1426 ± 114 0.03 6 ± 5442 ± 27 Control II 4 2.35 20 ± 6 1152 ± 142 0.54 BDL 373 ± 21 IsotypeCtrl 4 NA 41 ± 3 808 ± 52 NA 37 ± 8  326 ± 26

TABLE 7d Dose: 0.6 mg/kg Dose: 0.3 mg/kg Exp M4 (ED₉₉) Viral Viral MiceReduc- mAb Reduc- mAb per tion [ng/ml] tion [ng/ml] PID group (%) Serum(%) Serum Control I 5 >99 8451.9 ± 2562 96.9 3129.7 ± 403 ND: Notdetermined

TABLE 7e Dose: 0.15 mg/kg Dose: 0.05 mg/kg Exp M4 (ED₉₉) Viral ViralMice Reduc- mAb Reduc- mAb per tion [ng/ml] tion [ng/ml] PID group (%)Serum (%) Serum H1H3592P3 5 >99 1578.9 ± 256 90.6 524.0 ± 42 Control I 557.9 1561.2 ± 282 24.2 547.5 ± 59 Control II 5 96.7 1566.0 ± 354 48.5465.7 ± 85 Isotype Ctrl 5 NA 1406.0 ± 196 NA 375.3 ± 86 ND: NotdeterminedB. Cotton Rat Model

The exemplary antibodies H1H3627N and H1H3592P3 were selected for invivo RSV neutralization studies using cotton rats. Briefly, 6-8 week oldcotton rats (n=5) were injected IM at two doses (5 or 0.6 mg/kg) usingeither H1H3627N, H1H3592P3, control I, control II or isotype-matchedantibody.

One day post-injection, rats were challenged intranasally with 100 ul(10⁵ pfu) of RSV A2 strain. Four days post-infection, sera was drawn,rats were sacrificed, and lung and nasal tissues were extracted forviral titration. Lung homogenates were centrifuged to remove cellulardebris and a portion of supernatant was used to determine anti-RSV-F mAbconcentration in the lung. The remaining supernatant was used to makeserial dilutions, which were incubated with HEp-2 cells to allow viralentry. Subsequently, supernatant was removed and the cells were overlaidwith 1% methylcellulose. Six days later, cells were stained and plaqueswere counted and the log₁₀ viral reduction was calculated relative toisotype control.

Exemplary antibody H1H3592P3 was more efficacious in reducing the viralload in the lungs and nose than control I, and as efficacious as controlII in lungs and better in the nose. Exemplary antibody H1H3627N was onlybetter than control I and as efficacious as control II in the nose(Table 8). Specifically, at the 5 mg/kg dose, antibodies H1H3627N,H1H3592P3, control I and control II all effectively reduced RSVinfection in the lung to near undetectable levels compared to isotypecontrol (viral reduction log(10) fold change 2.33). However, in thenose, greater differentiation in neutralization efficacy betweenH1H3627N, H1H3592P3, control II compared to control I was evident.H1H3592P3 showed the greater reduction in viral load (2.65 logs)compared to H1H3627N (1.46 logs) or control II (1.33 logs).

At a lower administrated dose, greater differentiation in neutralizationefficacy between the three antibodies compared to control I was evidentin the lungs. At 0.6 mg/kg, H1H3592P3 showed similar reduction in viralload than control II (1.5 logs) and they were both more efficacious thancontrol I (0.624 logs). H1H3627N showed less efficacy than the otherthree antibodies.

Exemplary anti-RSV-F antibody H1H3592P3 was next selected for testingits ability to neutralize RSV subtype B in vivo using the cotton ratmodel. As with RSV/A, 6- to 8-week old cotton rats(n=4-6/group/experiment) were intramuscularly administered either 5 or0.6 mg/kg of H1H3592P3, Control I or Control II. The next day, animalswere challenged with 10^5 pfu of RSV/B strain 18537. Four dayspost-challenge, viral titers in the lungs and nose were determined alongwith serum antibody titers. The results shown in table 9 were datapooled from two independent experiments.

H1H3592P3 showed efficacy in reducing RSV/B viral load in lungs at bothhigh and low doses (Table 9). At 5.0 mg/kg, RSV/B viral load in thelungs was reduced by 2.21 logs with H1H3592P3, compared with a reductionof 2.11 logs by Control I and 2.18 logs by Control II. At 0.6 mg/kg,RSV/B viral load in the lungs was reduced by 1.29 logs with H1H3592P3,compared with a reduction of 0.75 logs by Control I and 0.83 logs byControl II.

Overall, H1H3592P3 showed superiority in neutralization of RSV Subtype Bin the lungs over both Control I and II at 0.6 mg/kg. At 5 mg/kg,H1H3592P3 showed comparable neutralizing ability than Control I andControl II in reducing viral load in the lungs.

The results indicate that H1H3592P3 is a potent neutralizer of RSVsubtype strains A and B in vivo in cotton rats, being a more effectiveneutralizer of RSV infection at high doses in the nose and at lowerdoses in the lungs. The efficacy at low doses indicates the possibilityof a lower dose regimen in the clinic.

TABLE 8 RSV-A viral reduction (log (10)) in cotton rats afteradministration of Anti-RSV-F antibodies Dose: 0.6 mg/kg Dose: 5.0 mg/kgExp R1 Viral Viral mAb Viral Viral mAb Rats Reduction Reduction [ng/ml]Reduction Reduction [ng/ml] per lung nose Serum lung nose Serum PIDgroup (log10) (log10) Day 4 (log10) (log10) Day 4 H1H3627N 5 0.34 0.223.43 ± 0.25 2.33 1.46 21.52 ± 5.47 H1H3592P3 5 1.66 0.19 3.49 ± 0.552.56 2.66 46.28 ± 7.69 Control I 5 0.62 0.21 3.04 ± 0.29 2.37 1.07 39.95± 5.23 Control II 5 1.50 0.20 4.26 ± 0.66 2.55 1.33 24.06 ± 2.96 IsotypeCtrl 4 NA NA 3.78 ± 0.99 NA NA 30.43 ± 6.66

TABLE 9 RSV-B viral reduction (log (10)) in cotton rats afteradministration of Anti-RSV-F antibodies Dose: 0.6 mg/kg Dose: 5.0 mg/kgExp R2 Viral Viral mAb Viral Viral mAb Rats Reduction Reduction [ng/ml]Reduction Reduction [ng/ml] per lung nose Serum lung nose Serum PIDgroup (log10) (log10) Day 4 (log10) (log10) Day 4 H1H3592P3 10 1.29 0.213.89 ± 0.99 2.21 0.86 42.31 ± 13.5 Control I 11 0.75 0.15 3.87 ± 0.732.11 0.79 35.28 ± 11.8 Control II 11 0.83 0.10 3.75 ± 0.49 2.18 1.2427.65 ± 7.49 Isotype 10 NA NA 3.56 ± 1.17 NA NA 34.28 ± 9.24 ControlC. Cotton Rat Model-Determination of the ED₉₉ of an Exemplary AntibodyH1H3592P3

Dose-ranging studies using the cotton rat were performed to determine atwhich dose an exemplary antibody H1H3592P3 would reduce viral loadby >99% (i.e. the ED₉₉). Cotton rats were prophylactically administeredan IM dose of H1H3592P3 or Control 1 antibody at either 10, 5, 2.5, 1.25or 0.62 mg/kg. Additionally an isotype control antibody was dosed in ateither 10 or 0.62 mg/kg to bracket the active agents in this study.Following antibody treatments an intranasal RSV challenge of eithersubtype A (RSV A2 strain) or subtype B (RSV B strain 18537) wasperformed. Four days post-infection, sera was drawn, rats weresacrificed, and lung tissue was extracted for viral titration. H1H3592P3at a dose of 0.62 mg/kg achieved >99% viral load reduction in the lungsas compared to Control 1 which required a dose of 2.5 mg/kg to reach thesame >99% viral reduction (Table 10). The mean terminal Control 1concentration (27 μg/mL) at the calculated ED₉₉ correlated well withpreviously published work (Scott and Lamb, 1999), which indicated that aserum palivizumab concentration (i.e. Control 1) of 30-40 μg/mL, at thetime of RSV infection, was associated with a 99% reduction in lung viralload. The mean terminal H1H3592P3 concentration (4.9 μg/mL) correlatedwell with the 4-fold lower dose delivered at its ED₉₉. Results againstsubtype B challenge were similar (Table 11) in that an ED₉₉ forH1H3592P3 was achieved at 2.5 mg/kg while Control 1 required roughly a4× greater dose (10 mg/kg) to obtain that same >99% viral lungreduction.

In summary these studies support that less frequent dosing of H1H3592P3may confer the same level of protection as the current monthly dosingparadigm used with palivizumab.

TABLE 10 Determination of the ED₉₉ for Anti RSV-F Antibodies After RSVSubtype A Challenge ED₉₉ Determination with RSV Subtype A PID 10 mg/kg 5mg/kg 2.5 mg/kg 1.25 mg/kg 0.62 mg/kg % Viral Lung ReductionH1H3592P3 >99 >99 >99 >99 >99 Control I >99 >99 >99 98.9 95.9 IsotypeCtrl NA NA NA NA NA Antibody Serum Concentration (ug/ml) H1H3592P3 107.2± 3.4 48.44 ± 6.1 20.15 ± 1.8 10.55 ± 1.5 4.91 ± 0.7 Control I 89.16 ±6.5 58.07 ± 6.3 26.93 ± 3.3 12.72 ± 2.2 6.65 ± 0.5 Isotype Ctrl  90.57 ±12.6 — — — 5.39 ± 0.5

TABLE 11 Determination of the ED₉₉ for Anti RSV-F Antibodies After RSVSubtype B Challenge ED₉₉ Determination with RSV Subtype B PID 10 mg/kg 5mg/kg 2.5 mg/kg 1.25 mg/kg 0.62 mg/kg % Viral Lung ReductionH1H3592P3 >99 >99 >99 98.4 96.7 Control I >99 97.7 98.4 96.3 88.2Isotype Ctrl NA NA NA NA NA Antibody Serum Concentration (ug/ml)H1H3592P3 98.04 ± 18.4 50.99 ± 7.8 27.82 ± 4.9 10.49 ± 1.7   7 ± 0.3Control I 98.89 ± 10.9 42.74 ± 8.9 26.46 ± 3.3 16.06 ± 2.2 7.58 ± 1.1Isotype Ctrl 99.72 ± 17.4 NA NA NA 5.38 ± 0.5

Example 6 Generation of a Bi-specific Antibody

Various bi-specific antibodies are generated for use in practicing themethods of the invention. For example, RSV-F specific antibodies aregenerated in a bi-specific format (a “bi-specific”) in which variableregions binding to distinct domains of the RSV-F protein are linkedtogether to confer dual-domain specificity within a single bindingmolecule. Appropriately designed bi-specifics may enhance overall virusneutralization efficacy through increasing both specificity and bindingavidity. Variable regions with specificity for individual domains arepaired on a structural scaffold that allows each region to bindsimultaneously to separate epitopes, or to different regions within onedomain. In one example for a bi-specific, heavy chain variable regions(V_(H)) from a binder with specificity for one domain are recombinedwith light chain variable regions (V_(L)) from a series of binders withspecificity for a second domain to identify non-cognate V_(L) partnersthat can be paired with an original V_(H) without disrupting theoriginal specificity for that V_(H). In this way, a single V_(L) segment(e.g., V_(L)1) can be combined with two different V_(H) domains (e.g.,V_(H)1 and V_(H)2) to generate a bi-specific comprised of two binding“arms” (V_(H)1-V_(L)1 and V_(H)2-V_(L)1). Use of a single V_(L) segmentreduces the complexity of the system and thereby simplifies andincreases efficiency in cloning, expression, and purification processesused to generate the bi-specific (See, for example, U.S. Ser. No.13/022759 and US2010/0331527).

Alternatively, antibodies that bind RSV-F and a second target, such as,but not limited to, for example, a second different anti-RSV-F antibody,or a toxoid, or a vaccine, may be prepared in a bi-specific format usingtechniques described herein, or other techniques known to those skilledin the art. Antibody variable regions binding to distinct regions may belinked together with variable regions that bind to relevant sites on,for example, a different viral antigen to confer dual-antigenspecificity within a single binding molecule. Appropriately designedbi-specifics of this nature serve a dual function. For example, in thecase of a bi-specific antibody that binds ie. RSV-F and RSV-G one may beable to better neutralize the virus, without the need for administrationof a composition containing two separate antibodies. Variable regionswith specificity for RSV-F, are combined with a variable region withspecificity for RSV-G and are paired on a structural scaffold thatallows each variable region to bind to the separate antigens.

The bi-specific binders are tested for binding and functional blockingof the target antigens, for example, RSV-F and RSV-G, in any of theassays described above for antibodies. For example, standard methods tomeasure soluble protein binding are used to assess the bispecificinteraction, such as Biacore, ELISA, size exclusion chromatography,multi-angle laser light scattering, direct scanning calorimetry, andother methods. Binding of bi-specific antibodies to both RSV-F and RSV-Gis determined through use of an ELISA binding assay in which syntheticpeptides representing the different antigens are coated onto the wellsof microtiter plates, and binding of a bi-specific is determined throughuse of a secondary detection antibody. Binding experiments can also beconducted using surface plasmon resonance experiments, in whichreal-time binding interaction of peptide to antibody is measured byflowing a peptide or bi-specific across a sensor surface on whichbi-specific or peptide, respectively, is captured. Functional in vitroblocking of both RSV-F and RSV-G by a bi-specific is determined usingany bioassay such as the neutralization assay described herein, or by invivo protection studies in appropriate animal models, such as thosedescribed herein, or in an in vivo model of lung inflammation.

Example 7 In Vitro Generation of RSV Escape Mutants to Determine theBinding Epitope of H1H3592P3

Generation of Escape Mutants to H1H3592P3

3×10⁵ Hep-2 cells/well were plated in a 6-well plate for 24 h.Concentrations of H1H3592P3, ranging from 50 ug/mL to 0.016 ug/mL weremixed with RSV subtype A strain 1540 or RSV subtype B strain 1580 for 1h at 37° C. After coincubation, the RSV/antibody mixture was added tothe previously seeded HEp-2 cells at a multiplicity of infection (MOI)of 10 plaque-forming units (pfu)/cell. Cells were incubated for 6 days,and cytopathic effects were monitored daily using light microscopy. Atday 6, contents of each well were harvested, adjusted to initialconcentration of antibody and used to infect freshly seeded HEp-2 cells.This serial passage was repeated until obvious cytopathic effects wereobserved at high concentrations of H1H3592P3 (50 ug/mL), which isapproximately 2 logs greater than the IC₅₀ of the antibody, suggestingthe presence of viral mutants. Supernatants from these wells wereconfirmed from the presence of resistant virus via amicro-neutralization assay (described below) and plaque isolation wasperformed in 10 cm tissue culture dishes. 10 individual plaques wereexpanded in 6-well plates and virus were re-tested for resistance viamicroneutralization. Sequencing was then performed on these viralmutants.

Microneutralization Assay

To confirm whether escape mutants generated under the pressure ofH1H3592P3 were resistant to neutralization, a microneutralization assayin Hep-2 cells was performed. Briefly, 10⁵ Hep2 cells cultured in DMEM1× medium, supplemented with 5% Hyclone FBS, L-glutamine andantibiotics, were seeded into 96-well clear bottom-black microplates andincubated for 16-18 hours (37C, 5% CO₂).

Next, various concentrations of antibodies, starting at 666 nM anddiluted 1:5 in media, were incubated for 2 hours (37C, 5% CO₂) with RSVwild-type (subtype A or B) or escape mutants from both subtype A and B,at an MOI from 0.04 to 0.4. Controls not containing virus or controlscontaining virus but no antibodies were included. All dilutions ofantibody were conducted in duplicates. After incubation, theantibody/virus mixture was added to cells and infection was allowed for3 days. Infection was determined by fixing the cells in 2% PFA and anELISA with Goat anti-RSV/anti-Goat HRP antibodies was performed.Luminescence reagents were added to the wells and signal was detectedusing a plate reader (Victor X3, Perkin Elmer). Luminescence values wereanalyzed by a three-parameter logistic equation over an 11-pointresponse curve (GraphPad Prism).

Results

Respiratory syncytial virus escape mutants were generated to map thespecific binding region of H1H3592P3 to RSV-F. Briefly, HEp-2 cells,infected with RSV strains 1540 (subtype A) or 1580 (subtype B) weresubjected to H1H3592P3 treatment ranging from 50 ug/mL to 0.016 ug/mL.After 6 days, contents from each well were used to infect freshly seededHEp-2 cells. This serial passage continued until cytopathic effects wereobserved in HEp-2 cells even in the presence of the highest antibodydose, indicating the presence of RSV viral mutants generated underselection pressure. Overall, viral mutants were isolated from tendistinct plaques, confirmed for neutralization resistance in thepresence of H1H3592P3 and subsequently sequenced.

Sequence analysis confirmed that escape mutations for H1H3592P3 werefound at amino acid positions 173 and 174 (S 173Y and T174K) of RSV-F(SEQ ID NO: 354), indicating that these amino acids play an importantrole in antibody binding and viral neutralization. Prior reports havedetermined that the binding epitopes for anti-RSV Control I and ControlII antibodies are located between S255-N276. The data from these studiessuggest a binding site for H1H3592P3 on RSV-F that plays a major role inviral neutralization (see table 12) and is distinct from that requiredfor previously established Control antibodies.

TABLE 12 Neutralization Efficacy of H1H3592P3 and anti- RSV ControlAntibodies on RSV subtype A and B Strains and Associated Escape MutantsH1H3592P3 Control I Control II Virus (IC50, pM) (IC50, pM) (IC50, pM) wtsubtype A (RSV/A) 177 1140 108 RSV/A S173Y Resistant 1710 170 Wt subtypeB (RSV/B) 290 1900 260 RSV/B S173T Resistant 1900 177 RSV/B T174KResistant 640 108 RSV/B S173T/T174K Resistant 980 218

Example 8 Determination of the Binding Epitope of H1H3592P3 to RSV-Fusing Hydrogen-Deuterium Exchange & Mass Spectrometry

Hydrogen/Deuterium Exchange (H/D exchange) in combination with pepticdigests and mass spectrometry was conducted to determine the bindingepitope of the anti-RSV-F antibody H1H3592P3 to recombinant RSV-F. TwoHID exchange formats (described in detail below) were employed: An‘on-solution/off-beads’ method in which RSV-F peptide fragments that areprotected by H1H3592P3 from back-exchange retain D₂0 and yield highermolecule weights (m/z values) by mass spectrometry and an‘on-beads/off-beads’ control method which establishes the baseline m/zvalues for all RSV-F peptides. Subtraction of the control m/z valuesfrom the m/z values obtained using the ‘on-solution/off beads’ methodyields certain amino acids regions that show non-zero delta m/z valuesi.e residual D₂0 that correspond to the binding epitope betweenH1H3592P3 and RSV-F.

Methods

On Solution/Off Beads Format

In the ‘on-solution/off-beads’ (on-exchange in solution followed byoff-exchange on beads) format, RSV-F.mmh protein (SEQ ID NO: 353) wasdeuterated for 5 min or 10 min in PBS buffer prepared with D₂O, and thenbound to H1H3592P3 covalently attached to N-hydroxysuccinimide (NHS)agarose beads (GE Lifescience) via a 2 min incubation. TheRSV-F/H1H3592P3 bead complex was washed with PBS buffer (prepared withnon-deuterated H₂O) and incubated in PBS buffer for half of theon-exchange time. After the off-exchange, the bound RSV-F was elutedfrom beads with an ice-cold low pH TFA solution. The eluted RSV-F wasthen digested with immobilized pepsin (Thermo Scientific) for 5 min. Theresulting peptides were desalted using ZipTip chromatographic pipettetips and immediately analyzed by UltrafleXtreme matrix assisted laserdesorption ionization time of flight (MALDI-TOF)-TOF mass spectrometry(MS).

On-Beads/Off Beads Format

In the ‘on-beads/off-beads’ (on-exchange on beads followed byoff-exchange on beads) format, RSV-F.mmh (SEQ ID NO: 353) was firstbound to H1H3592P3 agarose beads and then incubated for 5 min or 10 minin D₂O for on-exchange. The RSV-F/H1H3592P3 bead complex was washed withPBS buffer (prepared with non-deuterated H₂O) and incubated in PBSbuffer for half of the on-exchange time. After the off-exchange, thebound RSV-F was eluted from beads with an ice-cold low pH TFA solution.The eluted RSV-F was then digested with immobilized pepsin (ThermoScientific) for 5 min. The resulting peptides were desalted using ZipTipchromatographic pipette tips and immediately analyzed by MALDI-TOF-TOFmass spectrometry. The centroid values or average mass-to-charge ratios(m/z) of all the detected peptides were calculated and compared betweenthis and the ‘on-solution/off-beads’ experiment.

Peptide Identification

The identification of the peptides was carried out using liquidchromatography-Orbitrap Elite (Thermo Scientific).

Results

Table 13 is a detailed comparison of the delta centroid m/z values forall the RSV-F peptides detected by MALDI-TOF mass spectrometry followingH/D exchange and peptic digest. Two segments corresponding to aminoacids 161-171 (EGEVNKIKSAL, (SEQ ID NO: 355)) and 172-188(LSTNKAVVSLSNGVSVL, (SEQ ID NO: 356)) of SEQ ID NO: 354 had deltacentroid values higher than 0.20, a threshold observed in-house to beconsidered indicative of antibody-protein contact and thus an epitoperegion. It should also be noted that the peptide signal corresponding toamino acids 161-171 was not quantified in the 10 min on-exchangeexperiment due to low signal to noise. However, the delta value of 0.88,detected at the 5 min on-exchange experiment, is far above the 0.2threshold and can be attributed to the significant alteration in H/Dexchange rate upon RSV-F binding to H1H3592P3.

Furthermore the peptide segment corresponding to amino acids 172-188contains the amino acids of the two RSV escape mutants (S173Y and T174K;see example 7), which were resistant to H1H3592P3 treatment, indicatingthat these two amino acids play a role in antibody binding and viralneutralization. Thus the combination of sequencing escape RSV mutantsalong with H/D exchange support amino acids 161-188 of SEQ ID NO: 354defining at least in part the binding region in RSV-F for antibodyH1H3592P3.

TABLE 13 Centroid (m/z) Values of RSV-F Peptic Peptides After Back-exchange following deuteration in the Absence (on-solution/off- beads)and Presence (on-beads/off-beads) of H1H3592P3 Experiment I ExperimentII 5 min on-/2.5 min 10 min on-/5 min off-exchange off-exchange on- on-on- on- beads/ solution/ beads/ solution/ off beads off-beads off beadsoff-beads Residues (m/z) (m/z) delta (m/z) (m/z) delta 46-52 791.06791.10 0.04 791.06 791.15 0.09 48-56 1083.32 1083.37 0.05 1083.321083.35 0.03 48-58 1297.42 1297.44 0.02 1297.40 1297.44 0.04 79-921665.81 1665.96 0.15 1665.86 1665.89 0.03  94-107 1519.93 1520.00 0.061520.01 1520.09 0.07  96-107 1278.64 1278.61 −0.03 1278.61 1278.73 0.12 96-108 1434.61 1434.60 −0.01 1434.50 1434.63 0.13 148-160 1308.971309.12 0.16 N.A. N.A. N.A. 161-171 1188.72 1189.60 0.88 N.A. N.A. N.A.172-188 1689.44 1691.68 2.24 1689.60 1691.07 1.47 220-230 1390.021390.06 0.04 1389.98 1389.93 −0.05 220-232 1632.30 1632.34 0.04 1632.291632.37 0.08 223-230 1048.49 1048.54 0.05 1048.44 1048.55 0.11 223-2321291.16 1291.21 0.05 1291.12 1291.18 0.07 231-236 760.95 760.95 0.00761.02 760.95 −0.06 233-240 966.29 966.33 0.04 966.20 966.30 0.09233-249 1780.20 1780.39 0.19 1780.38 1780.38 0.00 261-277 1977.811977.91 0.10 1977.92 1977.80 −0.13 261-279 2205.05 2205.12 0.07 2205.102205.20 0.10 278-285 958.20 958.34 0.14 958.15 958.29 0.14 278-2861121.50 1121.57 0.07 1121.54 1121.59 0.05 278-289 1453.19 1453.16 −0.031453.14 1453.08 −0.06 280-286 894.20 894.22 0.02 894.29 894.28 −0.02280-289 1225.75 1225.80 0.05 1225.79 1225.81 0.02 280-290 1312.701312.70 −0.01 1312.86 1312.74 −0.13 457-467 1329.73 1329.82 0.09 1329.731329.76 0.03 468-477 1180.57 1180.67 0.10 1180.60 1180.42 −0.18 527-5452132.30 2132.32 0.02 2132.39 2132.38 −0.01 534-545 1318.54 1318.54 0.001318.64 1318.50 −0.13 537-545 988.92 988.87 −0.05 988.93 988.84 −0.08546-557 1528.62 1528.68 0.07 1528.64 1528.64 0.00 No ID 743.16 743.06−0.10 743.10 742.99 −0.11 No ID 844.01 843.98 −0.03 844.03 843.96 −0.07No ID 901.26 901.40 0.13 901.36 901.40 0.04 No ID 943.15 943.19 0.04943.24 943.20 −0.04 No ID 1090.41 1090.45 0.04 1090.48 1090.51 0.03 NoID 1143.51 1143.61 0.10 1143.53 1143.57 0.04 No ID 1325.52 1325.56 0.041325.54 1325.66 0.12 No ID 1353.69 1353.64 −0.06 1353.77 1353.61 −0.16No ID 1550.39 1550.44 0.05 1550.45 1550.40 −0.05 No ID 2074.49 2074.41−0.08 2074.52 2074.36 −0.15 No ID 2257.71 2257.70 −0.01 2257.89 2257.85−0.04 No ID 2365.83 2365.72 −0.12 2365.94 2365.87 −0.07 No ID 2385.182385.17 −0.01 2385.23 2385.25 0.02 No ID 2405.22 2405.09 −0.12 2405.172405.15 −0.02 No ID 2456.18 2456.24 0.07 2456.14 2456.09 −0.05 No ID2513.28 2513.26 −0.01 2513.32 2513.19 −0.14

Example 9 Respiratory Syncytial Virus Fusion (RSV-F) Protein AntibodiesDisplay Potent Neutralization Capabilities Across RSV Subtype A and BLaboratory Strains

H1H3592P3 and controls I and II antibodies were tested in a RSVmicro-neutralization assay to determine potency. Briefly, 10⁴ HEp-2cells cultured in DMEM 1× medium, supplemented with 5% Hyclone FBS,L-glutamine and antibiotics, were seeded into 96-well clear bottom-blackmicroplates and incubated for 16-18 hours (37° C., 5% CO₂). Next,various concentrations of antibodies, starting at 666 nM with subsequent1:5 dilutions in media, were incubated with various RSV subtype A labstrains provided by ATCC at an MOI of 0.042 for 2 hours (37C, 5% CO₂).Virus-free and irrelevant isotype controls were included.

Post incubation, the antibody:virus mixture was added to the HEp-2 cellsand infection was maintained for 3 days. The degree of infection wasdetermined by fixing cells in 2% PFA and performing an ELISA with Goatanti-RSV/anti-Goat HRP antibodies. Luminescence reagents were added tothe wells and signal was detected using a plate reader (Victor X3,Perkin Elmer). Luminescence values were analyzed by a three-parameterlogistic equation over an 11-point response curve (GraphPad Prism).

The antibodies of the invention displayed a broad range ofneutralization activities against the RSV lab strains (Table 14).Antibodies H1H3592P3 and AM22 showed similar potency than control II forRSV subtype A lab strains. Compared to control I, H1H3592P3 showed 15-17fold more potency (IC50 44-140 pM), while AM22 showed 9-23 fold morepotency (IC50 86-91 pM) (Table 14). For subtype B, antibody H1H3592P3showed similar potency than control II, but superior than AM22 andcontrol I. Compared to control I, H1H3592P3 showed 2-5 fold more potency(IC50 33-230 pM), while AM22 showed 0.13-2 fold more potency (IC50190-2508 pM).

This example demonstrates the efficacy of the antibodies of thisinvention to neutralize several lab strains of RSV from both subtype Aand B, in vitro, with greater potency than previously demonstrated forestablished controls.

TABLE 14 H1H3592P3 Control I Control II Control III Subtype/strain IC50(pM) IC50 (pM) IC50 (pM) IC50 (pM) A/A2 140 2080 202 91 A/Long 44 752 8386 B/18537 230 1190 187 660 B/1400 33 113 38 190 B/1A2 48 223 40 580B/9320 151 338 76 2508

Example 10 Respiratory Syncytial Virus Fusion (RSV-F) Protein AntibodiesDisplay Potent Neutralization Capabilities Across RSV Subtype A ClinicalIsolates

H1H3592P3 and controls I, II and III antibodies were tested in a RSVmicro-neutralization assay to determine potency. Briefly, 10⁴ HEp-2cells cultured in DMEM 1' medium, supplemented with 5% Hyclone FBS,L-glutamine and antibiotics, were seeded into 96-well clear bottom-blackmicroplates and incubated for 16-18 hours (37° C., 5% CO₂). Next,various concentrations of antibodies, starting at 666 nM with subsequent1:5 dilutions in media, were incubated with various RSV subtype Aclinical isolates provided by Dr. Moore (Emory University) at a range ofMOIs from 0.015 to 0.128 for 2 hours (37C, 5% CO₂). Virus-free andirrelevant isotype controls were included.

Post incubation, the antibody:virus mixture was added to the HEp-2 cellsand infection was maintained for 3 days. The degree of infection wasdetermined by fixing cells in 2% PFA and performing an ELISA with Goatanti-RSV/anti-Goat HRP antibodies. Luminescence reagents were added tothe wells and signal was detected using a plate reader (Victor X3,Perkin Elmer). Luminescence values were analyzed by a three-parameterlogistic equation over an 11-point response curve (GraphPad Prism).

The antibodies of the invention displayed a broad range ofneutralization activities against the RSV clinical isolates (Table 15).Antibody H1H3592P3 showed similar potency to controls II and III formost clinical isolates. Compared to control I, H1H3592P3 showed 10-22fold more potency (IC50 34-66 pM) (Table 15).

This example demonstrates the efficacy of the antibodies of thisinvention to neutralize several clinical isolates of RSV, in vitro, withgreater potency than previously demonstrated for established controls.

TABLE 15 RSV-F Antibodies Display Potent Neutralization CapabilitiesAcross RSV Subtype A clinical isolates H1H3592P3 Control I Control IIControl III MOI IC50 (pM) IC50 (pM) IC50 (pM) IC50 (pM) GenbankA2001/2-20 0.016 43 935 74 72 JX069798.1 A2001/3-12 0.018 66 1259 129 60JX069799.1 A1997/12-35 0.015 40 478 41 20 JX069800.1 A1998/3-2 0.128 35344 36 31 JX069801.1 A1998/12-21 0.026 34 580 68 43 JX069802.1 A2000/3-40.040 50 899 88 55 JX069803.1

Example 11 H1H3592P3 Blocks Viral Entry by Inhibiting Fusion of Virusand Cell Membranes

A study was done to determine the mechanism by which the antibodies ofthe invention block respiratory syncytial virus (RSV) infection. Oneexemplary antibody of the invention, H1H3592P3, was tested to determinewhether it acted to prevent/inhibit RSV fusion with host cells (FIG. 2Aand 2B). The mechanism of action for control I (the positive control mAbwhich is based on the sequence of palivizumab) was previously describedas inhibition of viral fusion to the host cell (Huang et al., J. ofVirol., (2010), August 84(16):8132-40). Because RSV-F is involved inboth attachment to the cell via the interaction of the host receptornucleolin, and fusion of the viral and plasma membranes, assays wereperformed to determine the mechanism of H1H3592P3.

The attachment assay (FIG. 2A) was performed by incubating RSV (subtypeA, strain A2) in the presence of either H1H3592P3 or the positivecontrol antibody (control I), then incubating the mixture with HEp-2cells at 4° C. for one hour to allow binding of the virus to the cells.Unbound virus was washed out, cells were fixed and the percentage ofattached virus was measured by ELISA. Heparin, which blocks RSVattachment, was used as a control.

Viral fusion was detected by allowing viral attachment at 4° C., washingout unbound virus, then incubating with H1H3592P3, positive Control I,or an isotype negative control antibody at 4° C. and moving cells to 37°C. to promote viral fusion and entry. Viral infection was measured 3days later by ELISA (FIG. 2B). RLU: Relative Luminescence Units.

H1H3592P3, like control I, blocks RSV fusion and not the attachment ofRSV to the cell surface, while the isotype (negative) control mAb had noeffect on viral fusion (FIG. 2B). Heparin effectively blocked RSVattachment to cells (Hallack et al., Virology (2000), 271 (2):264-75),whereas neither antibody inhibited RSV attachment (FIG. 2A). H1H3592P3blocked viral fusion in this assay format with an IC₅₀ of 230 pM, whilethe positive control mAb (control I) blocked viral fusion with an IC₅₀ 1nM (FIG. 2B). Similar results were observed with an RSV subtype B strain(data not shown).

Example 12 Octet Cross Competition of anti-RSV-F Antibodies for Bindingto RSV-F

Binding competition between a panel of anti-RSV-F mAbs was determinedusing a real time, label-free bio-layer interferometry assay on anOctet® HTX biosensor (Pall ForteBio Corp.). The entire experiment wasperformed at 25° C. in HBST kinetics buffer (0.01 M HEPES pH7.4,

0.15M NaCl, 3mM EDTA, 0.05% v/v Surfactant Tween-20, 0.1mg/mL BSA) withthe plate shaking at the speed of 1000rpm. To assess whether twoantibodies are able to compete with one another for binding to theirrespective epitopes on the recombinant RSV-F protein expressed with aC-terminal myc-myc-hexahistidine tag (RSV-F-mmH), around 0.36nm ofRSV-F-mmH was first captured onto anti-Penta-His antibody coated Octetbiosensor (Fortebio Inc, Cat# 18- 5079) by submerging the biosensors for3minutes into wells containing 10μg/mL solution of recombinantRSV-F-mmH. The antigen captured biosensors were then saturated with thefirst anti-RSV-F monoclonal antibody (subsequently referred to as mAb-1)by dipping into wells containing 100-200μg/mL solution of mAb-1 for10minutes. The biosensors were then subsequently dipped into wellscontaining 100- 200μg/mL solution of second anti-RSV-F monoclonalantibody (subsequently referred to as mAb-2) for 5minutes to check formAb-2 binding to RSV-F-mmH, which is pre-bound to mAb-1. The biosensorswere washed in HBST kinetics buffer in between every step of theexperiment. The real-time binding response was monitored throughout thecourse of the experiment and the maximum binding response for all thesteps was recorded. The response of mAb-2 binding to RSV-F-mmH pre-boundwith mAb-1 was measured and competitive/non-competitive behavior ofdifferent anti-RSV-F monoclonal antibodies was determined.

Results

Sequential binding studies performed on Octet® HTX demonstrate that noneof the anti-RSV-F monoclonal antibodies compete with each other and areable to bind non-competitively to RSV-F-mmH. As shown in Table 16,underlined values indicate the binding response for self-competition. Nocompetition between antibodies that suggest a distinct binding epitopeis represented in the values without underlining Binding of the firstanti-RSV-F monoclonal antibody (mAb-1) to the anti-His-capturedRSV-F-mmH protein does not prevent the binding of the second anti-RSV-Fmonoclonal antibody (mAb-2). For all the anti-RSV-F monoclonalantibodies in this study, the observed mAb-2 binding signal was found tobe comparable to that observed in the absence of mAb-1 (No mAb).Moreover, the observed binding of mAb-2 for all the anti-RSV-Fmonoclonal antibodies was found to be independent of the order ofbinding of anti-RSV-F antibody; suggesting that all the anti-RSV-Fantibodies under investigation have distinct binding epitopes.

TABLE 16 Cross-competition between anti-RSV-F monoclonal antibodies.Amount of Amount of 100- 10 μg/mL of 200 μg/mL Binding of mAb-2 to thePre- RSV_F · mmh of mAb-1 complex of Captured RSV-F- Captured ± BindingmmH & mAb-1 mAb-1 Std Dev (nm) Level (nm) mAb# 1 2 3 4 Comparator III0.36 ± 0.01 0.33 ± 0.01 1 0.01 0.34 0.44 0.00 (AM-22) H1H3592P3 0.36 ±0.01 0.35 ± 0.01 2 0.26 0.00 0.30 0.00 Comparator I 0.39 ± 0.01 0.45 ±0.02 3 0.29 0.23 0.01 −0.01  (Palivizumab) No mAb 0.36 ± 0.01 −0.01 ±0.01  4 0.20 0.17 0.36 0.00

What is claimed is:
 1. An isolated human antibody or antigen-bindingfragment thereof that binds specifically to RSV-F, wherein the antibodyor antigen-binding fragment comprises three heavy chain complementaritydetermining regions (CDRs) (HCDR1, HCDR2 and HCDR3) contained within aheavy chain variable region (HCVR) comprising the amino acid sequence ofSEQ ID NO: 274; and comprises three light chain CDRs (LCDR1, LCDR2 andLCDR3) contained within a light chain variable region (LCVR) comprisingthe amino acid sequence of SEQ ID NOs: 282, wherein the CDRs areidentified by the Kabat definition, the Chothia definition, or the AbMdefinition.
 2. The isolated human antibody or antigen-binding fragmentof claim 1, comprising: (a) a HCDR1 domain having the amino acidsequence of SEQ ID NO: 276; (b) a HCDR2 domain having the amino acidsequence of SEQ ID NO: 278; (c) a HCDR3 domain having the amino acidsequence of SEQ ID NO: 280; (d) a LCDR1 domain having the amino acidsequence of SEQ ID NO: 284; (e) a LCDR2 domain having the amino acidsequence of SEQ ID NO: 286; and (f) a LCDR3 domain having the amino acidsequence of SEQ ID NO:
 288. 3. The isolated antibody or antigen-bindingfragment of claim 2, comprising the HCVR/LCVR amino acid sequence pairof SEQ ID NOs: 274/282, wherein the antibody or antigen-binding fragmentbinds to RSV-F within amino acids 161-188of SEQ ID NO:
 354. 4. Anisolated nucleic acid molecule encoding the antibody or antigen-bindingfragment of claim
 1. 5. An expression vector comprising the nucleic acidmolecule of claim
 4. 6. A host cell comprising the expression vector ofclaim
 5. 7. A method for treating a respiratory syncytial virus (RSV)infection, the method comprising administering an antibody orantigen-binding fragment of claim 1, or a composition comprising anantibody or antigen-binding fragment of claim 1, to a patient in needthereof.
 8. The method of claim 7, wherein: (a) the RSV infection iscaused by a subtype A or a subtype B respiratory syncytial virus; and/or(b) the patient in need thereof is a patient at high risk of acquiringan RSV infection, or a patient who may experience a more severe form ofthe RSV infection due to an underlying or pre-existing medicalcondition.
 9. The method of claim 8, wherein: (a) the patient is apre-term infant, a full term infant, a child greater than or equal toone year of age with or without an underlying medical condition (e.g.congenital heart disease, chronic lung disease, cystic fibrosis,immunodeficiency, a neuromuscular disorder), an institutionalized orhospitalized patient, or an elderly adult (greater than 65 years of age)with or without an underlying medical condition such as congestive heartfailure or chronic obstructive pulmonary disease); or (b) the patientsuffers from a condition resulting from a compromised pulmonary,cardiovascular, neuromuscular, or immune system.
 10. The method of claim9, wherein the condition is selected from the group consisting of anabnormality of the airway, a chronic lung disease, a chronic heartdisease, a neuromuscular disease that compromises the handling ofrespiratory secretions and immunosuppression.
 11. The method of claim10, wherein: (a) the chronic lung disease is chronic obstructivepulmonary disease (COPD), cystic fibrosis, or bronchopulmonarydysplasia, optionally wherein the chronic heart disease is congestiveheart failure (CHF), or congenital heart disease; and/or (b) theimmunosuppression is a result of severe combined immunodeficiency orsevere acquired immunodeficiency, or is a result of any other infectiousdisease or cancerous condition that leads to immunosuppression, or is aresult of treatment with immunosuppressant drug therapy or radiationtherapy.
 12. The method of claim 7, wherein: (a) the antibody orantigen-binding fragment thereof is administered via a route selectedfrom the group consisting of intravenously, intramuscularly, andsubcutaneously; and/or (b) the antibody or antigen-binding fragment isadministered to the patient in combination with a second therapeuticagent.
 13. A pharmaceutical composition comprising the antibody orantigen binding fragment thereof of claim 1 and a pharmaceuticallyacceptable carrier.
 14. An isolated human antibody or antigen-bindingfragment thereof that binds specifically to RSV-F, wherein the antibodyor antigen-binding fragment comprises three heavy chain complementaritydetermining regions (CDRs) (HCDR1, HCDR2 and HCDR3) contained within aheavy chain variable region (HCVR) comprising the amino acid sequence ofSEQ ID NO: 338; and comprises three light chain CDRs (LCDR1, LCDR2 andLCDR3) contained within a light chain variable region (LCVR) comprisingthe amino acid sequence of SEQ ID NOs: 346, wherein the CDRs areidentified by the Kabat definition, the Chothia definition, or the AbMdefinition.
 15. The isolated human antibody or antigen-binding fragmentof claim 14, comprising: (a) a HCDR1 domain having the amino acidsequence of SEQ ID NO: 340; (b) a HCDR2 domain having the amino acidsequence of SEQ ID NO: 342; (c) a HCDR3 domain having the amino acidsequence of SEQ ID NO: 344; (d) a LCDR1 domain having the amino acidsequence of SEQ ID NO: 348; (e) a LCDR2 domain having the amino acidsequence of SEQ ID NO: 350; and (f) a LCDR3 domain having the amino acidsequence of SEQ ID NO:
 352. 16. The isolated antibody or antigen-bindingfragment of claim 15, comprising the HCVR/LCVR amino acid sequence pairof SEQ ID NOs: 338/346.
 17. An isolated nucleic acid molecule encodingan antibody or antigen-binding fragment of claim
 14. 18. An expressionvector comprising the nucleic acid molecule of claim
 17. 19. A host cellcomprising the expression vector of claim
 18. 20. A method for treatinga respiratory syncytial virus (RSV) infection, the method comprisingadministering an antibody or antigen-binding fragment of claim 14, or acomposition comprising an antibody or antigen-binding fragment of claim14, to a patient in need thereof.
 21. The method of claim 20, wherein:(a)the RSV infection is caused by a subtype A or a subtype B respiratorysyncytial virus; and/or (b) the patient in need thereof is a patient athigh risk of acquiring an RSV infection, or a patient who may experiencea more severe form of the RSV infection due to an underlying orpre-existing medical condition.
 22. The method of claim 21, wherein: (a)the patient is a pre-term infant, a full term infant, a child greaterthan or equal to one year of age with or without an underlying medicalcondition (e.g. congenital heart disease, chronic lung disease, cysticfibrosis, immunodeficiency, a neuromuscular disorder), aninstitutionalized or hospitalized patient, or an elderly adult (greaterthan 65 years of age) with or without an underlying medical conditionsuch as congestive heart failure or chronic obstructive pulmonarydisease); or (b) the patient suffers from a condition resulting from acompromised pulmonary, cardiovascular, neuromuscular, or immune system.23. The method of claim 22, wherein the condition is selected from thegroup consisting of an abnormality of the airway, a chronic lungdisease, a chronic heart disease, a neuromuscular disease thatcompromises the handling of respiratory secretions andimmunosuppression.
 24. The method of claim 23, wherein: (a) the chroniclung disease is chronic obstructive pulmonary disease (COPD), cysticfibrosis, or bronchopulmonary dysplasia, optionally wherein the chronicheart disease is congestive heart failure (CHF), or congenital heartdisease; and/or (b) the immunosuppression is a result of severe combinedimmunodeficiency or severe acquired immunodeficiency, or is a result ofany other infectious disease or cancerous condition that leads toimmunosuppression, or is a result of treatment with immunosuppressantdrug therapy or radiation therapy.
 25. The method of claim 20, wherein:(a) the antibody or antigen-binding fragment thereof is administered viaa route selected from the group consisting of intravenously,intramuscularly, and subcutaneously; and/or (b) the antibody orantigen-binding fragment is administered to the patient in combinationwith a second therapeutic agent.
 26. A pharmaceutical compositioncomprising the antibody or antigen binding fragment thereof of claim 14and a pharmaceutically acceptable carrier.